American Heart Association finally sees the light on aspirin

Some of us (ahem, ahem) have been saying for years that there was just not enough good data out there to support most of the people who were indulging in the oh-so-widespread practice of taking a daily low-dose aspirin (ASA) in order to, well, in order, to try to live longer, which is by far the main reason most people start taking daily aspirin.

The theory was – and still is – that since aspirin lowers the risk of clotting, taking a low dose of aspirin every day can lower the risk of heart attacks and strokes, most of which are linked to arterial blood clots.

And that’s certainly true, but . . . (there is always a but in this business, and in this case, it’s a big but).

But since aspirin reduces clotting, it also consequently increases the risk of major bleeding (in the brain as a hemorrhagic stroke, in the gut as a major GI hemorrhage, and elsewhere), a risk that goes up substantially with age, so there is a very clear tradeoff in taking aspirin: Good – it prevents some kinds of strokes and heart attacks; bad – it raises the risk of other strokes and major bleeds.

In other words, as we get older, the potential benefits of regular use of aspirin start shrinking somewhat while the risks start increasing substantially, which is why – full disclosure – I have never taken daily ASA even though I have a pretty high LDL level (for which I take a low-dose statin) as well as high blood pressure (for which I take a low-dose diuretic).

This reluctance to take aspirin has put me at odds with several doctors who on the basis of guidelines issued from nearly all cardiac specialty groups such as the American Heart Association (AHA) advised me to start taking aspirin regularly.

Well, just this week, the AHA did a near-180 degree turn and released recommendations that no one over 70 should take ASA regularly (I think the AHA will eventually change that to anyone over age 65 and maybe even younger).

Nor should anyone who is at high risk of bleeding.

Rather, the focus on preventing cardiovascular problems should be a strong emphasis on – hold your breath! – lifestyle adjustments such as becoming more active and not smoking and eating well.

And for younger people, the only ones who should be sure to take aspirin regularly, the AHA says, are those who have had had a previous heart attack or stroke (or who have a stent) and some others who are at excessively high risk of heart attack or stroke.

As for the others – the vast majority of daily aspirin-takers who are without significant heart disease but who are taking the drug “just to be sure, you know” – the AHA now says that there is no reason to continue this regime, although as always, everyone cautions that you should speak to your family doc before you make any changes to your routine.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” according to a statement from Roger Blumenthal, co-chair of the new AHA guidelines.

Great to see that the AHA has finally caught up to AH.