Taking aspirin for heart attack prevention for many years was recommended by doctors and promoted by aspirin manufacturers; however, that has all recently changed. That recommendation has been retracted for healthy, older adults who do not have a high risk of or existing heart disease according to the American College of Cardiology and the American Heart Association. European guidelines, in contrast, do not recommend using any anti-clotting treatments, such as aspirin, at any age.
Many doctors in the United States still consider aspirin for certain patients who are at high-risk for high cholesterol or those who have issues managing their blood sugar levels – that is, as long as there is no increased risk for internal bleeding. Three separate recent studies showed not only that taking a low-dose aspirin is a waste of money for healthy older adults, but it can also raise their risk of internal bleeding, which can lead to early death.
New Recommendations for a New Way of Thinking
Dr. Roger Blumenthal, a John Hopkins cardiologist who co-chaired the new aspirin guidelines said, “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin.” Echoing his sentiment was Dr. Kevin Campbell, a cardiologist in North Carolina who explained, “For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol. This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention.”
Campbell explains that using aspirin by younger people is considered a class 2b recommendation. This means that it isn’t the best course of action. “There is much debate among experts, and the data is not definitive.” Campbell says he “would advocate a healthy lifestyle, smoking cessation and risk-factor modification before even considering aspirin therapy in a patient without known cardiovascular disease.”
The new guidelines also state that lifestyle changes such as a healthy diet, weight loss, avoiding smoking, and regular exercise are the best ways to prevent heart disease in anyone with low-density lipoprotein (LDL) levels of more than 190 milligrams per deciliter.
It is important to remember that aspirin can still be life-saving for patients who are not at risk of internal bleeding who have had a heart attack in the past, stents inserted for the unclogging of arteries, and for those who have had open-heart surgery.
“Ultimately, we must individualize treatment for each patient, based on their individual situation,” Campbell said.