Widespread
aspirin use despite few benefits, high risks
Beth Israel Deaconess Medical Center
Medical consensus once supported daily use of low dose aspirin
to prevent heart attack and stroke in people at increased risk for
cardiovascular disease (CVD).
But in 2018, three major clinical trials cast doubt on that conventional wisdom, finding few benefits and consistent bleeding risks associated with daily aspirin use.
Taken together, the findings led the American Heart Association and American College of Cardiology to change clinical practice guidelines earlier this year, recommending against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.
But in 2018, three major clinical trials cast doubt on that conventional wisdom, finding few benefits and consistent bleeding risks associated with daily aspirin use.
Taken together, the findings led the American Heart Association and American College of Cardiology to change clinical practice guidelines earlier this year, recommending against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.
Aspirin use is widespread among groups at risk for harm including older adults and adults with peptic ulcers -- painful sores in the lining of the stomach that are prone to bleeding that affect about one in ten people.
In a research report published today in Annals of Internal Medicine, researchers from Beth Israel Deaconess Medical Center (BIDMC) report on the extent to which Americans 40 years old and above use aspirin for primary prevention of cardiovascular disease.
"Although prior American Heart Association and American
College of Cardiology guidelines recommended aspirin only in persons without
elevated bleeding risk, the 2019 guidelines now explicitly recommend against
aspirin use among those over the age of 70 who do not have existing heart
disease or stroke," said senior author Christina C. Wee, MD, MPH, a
general internist and researcher at BIDMC and Associate Professor of Medicine
at Harvard Medical School.
"Our findings suggest that a substantial portion of adults may be taking aspirin without their physician's advice and potentially without their knowledge."
"Our findings suggest that a substantial portion of adults may be taking aspirin without their physician's advice and potentially without their knowledge."
Using data from the 2017 National Health Interview Survey
(NHIS), a nationally representative survey of U.S. households conducted before
the release of the new guidelines, Wee and colleagues characterized aspirin use
for primary prevention of CVD.
The team found that about a quarter of adults aged 40 years or older without cardiovascular disease -- approximately 29 million people -- reported taking daily aspirin for prevention of heart disease. Of these, some 6.6 million people did so without a physician's recommendation.
The team found that about a quarter of adults aged 40 years or older without cardiovascular disease -- approximately 29 million people -- reported taking daily aspirin for prevention of heart disease. Of these, some 6.6 million people did so without a physician's recommendation.
Concerningly, nearly half of adults 70 years and older without a
history of heart disease or stroke reported taking aspirin daily. The authors
noted that a history of peptic ulcer disease -- another contraindication for
the routine use of aspirin -- was not significantly associated with lower
aspirin use as one would have expected.
"Our findings show a tremendous need for health care
practitioners to ask their patients about ongoing aspirin use and to advise
them about the importance of balancing the benefits and harms, especially among
older adults and those with prior peptic ulcer disease," said lead author
Colin O'Brien, MD, a senior internal medicine resident at BIDMC and fellow at
Harvard Medical School.
Coauthor, Stephen Juraschek, MD, PhD, a primary care physician
at BIDMC, cautions that "these findings are applicable to adults who do
not have a history of cardiovascular disease or stroke. If you are currently
taking aspirin, discuss it with your doctor to see if it is still needed for
you."
Juraschek, who is also an Assistant Professor at Harvard Medical
School, is supported by grant K23HL135273 from the National Heart, Lung and
Blood Institute of the National Institutes of Health.