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Change in Thinking for Low Dose Aspirin and Heart Disease Prevention

For many years doctors have been recommending that those at potential risk for heart disease take daily low dose aspirin. Recently, there has been a change in this thinking.

According to new guidelines recently released, older folks who do not already have heart disease should abandon the daily low-dose aspirin regimen. The new guidelines came from the influential health analysis group, the U.S. Preventive Services Task Force.

According to the Task Force, bleeding risks for adults in their 60s and up who haven’t had a heart attack or stroke outweigh any potential benefits from aspirin. The new advice is only for those over 60. The panel said there may be a small benefit for adults in their 40s who have no bleeding risks. For those in their 50s, the panel softened advice, and said evidence of benefit is less clear.

The recommendations are meant for people with high blood pressure, high cholesterol, obesity, or other conditions that increase their chances for a heart attack or stroke. Regardless of age, adults should talk with their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said task force member Dr. John Wong, a primary-care expert at Tufts Medical Center.

“Aspirin use can cause serious harms, and risk increases with age,’’ he said.

If finalized, the advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.

Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice.

The task force previously said a daily aspirin might also protect against colorectal cancer for some adults in their 50s and 60s, but the updated guidance says more evidence of any benefit is needed.

Aspirin is best known as a pain reliever, but it is also a blood thinner that can reduce chances for blood clots. But aspirin also has risks, even at low doses — mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.

The guidance was posted online to allow for public comments until Nov. 8. The group will evaluate that input and then make a final decision.

The U.S. Preventive Services Task Force is not a government agency and should not be confused with the FDA, the CDC, or any other government healthcare body. They are an independent panel of disease-prevention experts that analyzes medical research and literature and issues periodic advice on measures to help keep Americans healthy. Newer studies and a re-analysis of older research prompted the updated advice, Wong said.

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