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Can an aspirin a day keep heart attacks at bay?

April 25, 2016


Minnesota doctors welcomed recent federal health guidelines on daily use of low-dose aspirin to prevent heart attacks and strokes.

The new advice — which spells out by age and risk who is likely to benefit from taking an 81 milligram-pill a day — is clear and helpful, many doctors say.

"We’ve had a lot of patients who decided for whatever reason on their own to start taking aspirin," said Dr. Rae Ann Williams, who specializes in internal medicine at HealthPartners’ Como Clinic in St. Paul. "This recommendation really helps us tailor that recommendation and have a much better conversation with patients about whether or not they are at high risk, and help guide them in their decision-making."

Numerous studies have shown that taking a low-dose aspirin a day can prevent a heart attack or stroke, leading causes of death and disability in the United States.

But for some people, the risks associated with following a daily aspirin regimen — including stomach bleeding and allergic reactions to aspirin — may outweigh the benefits.

So how can you tell if you are a good candidate for daily aspirin use?

Here’s what the new guidelines, developed by the U.S. Preventive Services Task Force, advise:

— A daily low-dose aspirin is recommended for those adults 50-59 whose life expectancy is at least a decade and who have a 10 percent or higher chance of a heart attack or other cardiovascular event. They also must have only an average risk for stomach bleeding.

— Adults 60-69 with a similar risk profile are advised to consult their doctor about possible daily aspirin use.

— Taking an aspirin daily was not recommended for adults younger than 50 or older than 69.

The new guidelines are precise, said Dr. Alan Hirsch, a cardiologist and University of Minnesota professor who is helping spearhead a statewide public health campaign called "Ask About Aspirin."

"This is somewhat clearer and more data-driven than the previous ones," he said referring to earlier recommendations. "This guideline creates a simple middle-age [50-59] range for which the green light and red light are clear."

It also reinforces a central message of the campaign: Know your risk and talk to your doctor.

The campaign’s goal over the next five years is to support the state’s heart disease and stroke prevention plan by making sure federal recommendations on aspirin are easy to use, for patients and doctors alike.

"Just like immunization for kids and air bags, it’s easy to get lost in complexities of recommendations," Hirsch said. "Prevention needs to be made easy."

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DIY ASSESSMENT

To that end, the campaign includes an interactive website (askaboutaspirin.umn.edu) with a self-assessment tool that allows people to find out what their risks are and answer questions to help determine whether aspirin is something they should consider taking regularly.

However, for those who are older or younger than the group highlighted in the new guidelines, questions linger.

Jerry Weld, 82, said he wasn’t sure whether he should keep taking his daily aspirin pill after he heard about the latest advice from the federal task force. "It wasn’t clear for my age group," he said.

Weld started taking aspirin after he’d had a heart stent put in and his health providers recommended it, he said. The new recommendations are for people who haven’t had previous heart issues, Williams said.

Hirsch pointed out that the guidelines don’t say NOT to take a daily baby aspirin if you’re younger than 50 or older than 60. They simply state that there isn’t enough data to support a recommendation for people outside the 50-59 age range.

"Because it doesn’t really tell you what to do below 50 or after 59, I do fear it creates confusion," he said. "So my worry is that this guideline doesn’t accurately say what every Minnesota primary physician and cardiologist knows, which is it really is a continuum of risk by age and risk factors."

Williams echoed that concern. She predicted there will be plenty of patients over 70 wondering what they should do.

"[Federal authorities are] not saying one way or another, but it does leave a little bit of a question there," she said.

That just means that doctors like her will have to make a point of talking to their patients about their aspirin questions, weighing the overall risks against benefits, before deciding what to do.

"The best thing about this is it gives us much more clear recommendations that we can give to our patients to have an intentional conversation about whether daily aspirin is right for them," she said.

 

 


McClatchy-Tribune Information Services