What do the new guidelines mean for you?
The draft guidelines from the Preventive Services Task Force might not offer a lot of clear yes’s and no’s about who should and shouldn’t take aspirin for primary prevention. And guidelines from other groups offer differing advice.
Guidelines from The American Heart Association, American College of Cardiology and American Diabetes Association all endorse aspirin for primary prevention in certain higher-risk patients. However, the Food and Drug Administration denied a petition from the aspirin manufacturer Bayer Inc for wording on their label that said aspirin could prevent heart attacks and strokes for people who had never had them.
And the European Society of Cardiology does not endorse aspirin for primary prevention for any patient – even those at high risk.
But, the “over-the-counter” availability of aspirin means that Americans, many Europeans and potential patients all over the world can decide for themselves whether or not to take aspirin. And many are deciding to do so. A national survey that we published in 2015 showed that nearly half of all US adults without CVD indicated that they “regularly” used aspirin as a preventive therapy.
So what should patients do? If you are over the age of 40 and don’t have a history of cardiovascular disease, check your predicted 10-year risk of CVD.
If your individual risk is greater than 10%, talk to your doctor about taking aspirin. Patients who don’t have a risk of bleeding could be considered good candidates for therapy, but they should understand that the odds of a serious bleed are about the same as the odds of preventing a heart attack or stroke. Not all patients will want to take the trade-off.
For patients who are under 70 with a CVD risk of less than 10%, aspirin therapy should generally be avoided.
While it is widely believed that these new task force recommendations will cut down on how many people go on an aspirin regimen in the US, that remains to be seen. It depends whether busy primary care providers read and agree with the guidelines, and then translate them into clinical practice.