New guidelines advise against aspirin to prevent heart disease

Most healthy people shouldn’t take aspirin to prevent a first heart attack, major heart-health organisations now recommend.

New guidelines recommend against the use of aspirin as a heart attack preventer. Picture: istock

Most healthy people shouldn’t take aspirin to prevent a first heart attack or cardiovascular disease, major heart-health organisations now recommend, saying the risk of serious bleeding outweighs the benefits.

Aspirin, the pain reliever, became increasingly used for the purpose of preventing a first heart attack after studies in the 1980s and 1990s showed a benefit.

But the American College of Cardiology and American Heart Association said low-dose aspirin shouldn’t be given on a routine basis for the purpose of preventing heart attacks and other heart disease in people 70 and older or adults of any age who are at increased risk of bleeding. These guidelines apply to people who haven’t been previously diagnosed with heart disease.

“Aspirin should be used very sparingly,” Dr. Eduardo Sanchez, chief medical officer for prevention at the American Heart Association, said in an interview.

Low-dose aspirin may be considered to prevent heart attacks in adults ages 40 to 70 who are at higher risk for cardiovascular disease but not at increased risk of bleeding, according to the new guidelines. People at higher risk for heart disease include those with a strong family history of it.

Aspirin is still recommended for so-called “secondary prevention” — to avert heart attacks in people already diagnosed with cardiovascular disease linked to plaque build-up in the arteries. Studies have shown this use of aspirin reduces risks of subsequent heart attacks and strokes.

The medical organisations made the revised aspirin recommendation as part of a new set of “primary prevention” guidelines for people who haven’t been diagnosed with heart disease. Doctors presented the guidelines at an ACC conference in New Orleans.

The change follows newer studies that flagged a bleeding risk for aspirin, including gastrointestinal bleeding.

One study of more than 19,000 older adults found that using low-dose aspirin to prevent cardiovascular disease significantly raised the risk of major haemorrhage without significantly cutting the risk of cardiovascular disease, versus a placebo, according to the New England Journal of Medicine in October.

The new studies “really have shown us the place for aspirin has diminished in terms of primary prevention,” Dr. Amit Khera, director of the preventive cardiology program at UT Southwestern Medical Center in Dallas, said at a press conference about the new guidelines.

“Fewer people should be taking aspirin” for this purpose, he added. Dr. Gené van den Ende, the head of US Consumer Medical at leading aspirin manufacturer Bayer AG, said the medicine is approved for secondary prevention of cardiovascular events. She said patients should consult with their doctors before making any decisions about stopping use of the drug.

There are more proven strategies for healthy people to ward off cardiovascular disease, said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. He cited regularly exercising, avoiding weight gain, monitoring cholesterol levels and blood pressure, and taking appropriate medications if not within healthy ranges.

The Wall Street Journal