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If you're taking a daily aspirin for your heart, you may want to reconsider.
For years, many middle-aged people have taken the drug in hopes of reducing the chance of a heart attack or stroke. Americans bought more than 44 million packages of low-dose aspirin marketed for heart protection in the year ended September, up about 12% from 2005, according to research firm IMS Health.
Now, medical experts say some people who are taking aspirin on a regular basis should think about stopping. Public-health officials are scaling back official recommendations for the painkiller to target a narrower group of patients who are at risk of a heart attack or stroke. The concern is that aspirin's side effects, which can include bleeding ulcers, might outweigh the potential benefits when taken by many healthy or older people.
'Not everybody needs to take aspirin,' says Sidney Smith, a professor at the University of North Carolina who is chairing a new National Institutes of Health effort to compile treatment recommendations on cardiovascular-disease prevention. Physicians are beginning to tailor aspirin recommendations to 'groups where the benefits are especially well established,' he says.
Doctors generally agree that most patients who have already suffered a heart attack or ischemic stroke, the type caused by a clot or other obstruction blocking an artery to the brain, should take regular low-dose aspirin. But for people without heart disease, the newest guidelines from the U.S. Preventive Services Task Force say much more clearly than before when aspirin should be administered.
The guidelines, announced last year, suggest aspirin for certain men 45 to 79 years old with elevated heart-disease risk because of factors like cholesterol levels and smoking. For women, the guidelines don't focus on heart risk. Instead, the task force recommends certain women should take aspirin regularly if they are 55 to 79 and are in danger of having an ischemic stroke, for reasons that could include high blood pressure and diabetes.
The panel urged doctors to factor in conditions that could increase a patient's risk of bleeding from aspirin, which tends to rise with age. The group didn't designate a dose, but suggested that an appropriate amount might be 75 milligrams a day, which is close to the 81mg contained in low-dose, or 'baby,' aspirin. The task force didn't take a position on aspirin for people who are 80 and older because of a lack of data in this age group.
Aspirin acts as a blood thinner, which is believed to account for much of its benefit of protecting against heart attacks and strokes. But that same action, along with a tendency to deplete the stomach's protective lining, can lead to a danger of gastrointestinal bleeding and possibly bleeding in the brain.
The task force issued its latest guidelines after reviewing the evidence from a number of studies on aspirin's benefits and risks. The recommendations update the panel's previous guidelines from 2002, which were more broadly written. Those suggested aspirin use for people of any age who were at elevated risk of heart disease.
'We would like doctors to re-look at their patients who are on aspirin and consider recommending stopping it where the chance of harm outweighs the benefit,' says Ned Calonge, a Colorado public-health official who serves as the task force's chairman. He notes, however, that in studies of healthy people taking aspirin, the actual rates of bleeding and of prevented heart attacks were very low. 2010-03-02
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