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AHA No Longer Recommends Daily Aspirin for Heart Health

AHA No Longer Recommends Daily Aspirin for Heart Health


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The AHA’s latest CVD prevention guidelines advise against taking low-dose aspirin to prevent heart attacks and strokes.

An aspirin a day keeps heart attacks away—or does it? According to the latest Guideline on the Primary Prevention of Cardiovascular Disease, the AHA and American College of Cardiology no longer recommend taking a daily low-dose aspirin for heart health. After decades of advising low-dose aspirin as an effective preventative measure for heart attacks and stroke, the new 2019 guidelines now say aspirin be used infrequently due to “lack of net benefit.”

This drastic change in the AHA’s guidelines comes after a recent, large-scale study on the subject—the Aspirin in Reducing Events in the Elderly (ASPREE) Study, which discovered not only was aspirin ineffective in preventing heart problems, but it actually led to a higher chance of hemorrhage than placebo. Upon further review of this study, researchers found the otherwise-healthy participants taking the daily low-dose aspirin were also linked to a higher mortality rate in general.

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"Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease," John Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the new guidelines, said in a statement. "It's much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin."

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Blumenthal went on to say more than 80 percent of all cardiovascular events are preventable—but we are falling short in implementing the proper strategies and lifestyle choices to do so. This is concerning since heart disease is the leading cause of death in the U.S., with stroke and diabetes not too far behind. These preventative lifestyle strategies are listed in the new preventative guidelines:

  • All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed meats, refined carbohydrates, and sugar-sweetened beverages. For adults with overweight/obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.
  • Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity, or 75 minutes per week of vigorous-intensity physical activity.
  • All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.

The bottom line: Eating a more plant-forward, whole foods diet and engaging in daily exercise are beneficial for not only our hearts—but our overall well-being. However, if you are at risk for cardiovascular issues, it is important to consult your doctor before making any drastic lifestyle changes.


Daily low-dose aspirin no longer recommended as heart attack preventative for older adults

If you're a healthy older adult looking for ways to reduce your risk of heart attack and stroke, don't turn to that age-old standby: daily low-dose aspirin. It's no longer recommended as a preventative for older adults who don't have a high risk or existing heart disease, according to guidelines announced Sunday by the American College of Cardiology and the American Heart Association.

"For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol," said North Carolina cardiologist Dr. Kevin Campbell, who wasn't involved in the new guidelines. "This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention."

Doctors may consider aspirin for certain older high-risk patients, such as those who have trouble lowering their cholesterol or managing their blood sugars, as long as there is no increased risk for internal bleeding, the guidelines say. European guidelines recommend against the use of anti-clotting therapies such as aspirin at any age.

"Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease," John Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the new guidelines, said in a statement. "It's much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin."

Using aspirin in younger age groups "is now a class 2b recommendation," Campbell said, "meaning that it is not necessarily the best course of action there is much debate among experts, and the data is not definitive."

However, personally, 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."

However, for anyone who has had a stroke, heart attack, open-heart surgery or stents inserted to open clogged arteries, aspirin can be life-saving.

"Ultimately, we must individualize treatment for each patient, based on their individual situation," Campbell said.

New research on aspirin

Three recent studies found that taking a daily low-dose aspirin is, at best, a waste of money for healthy older adults. At worst, it may raise their risk of internal bleeding and early death.

"Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding," Blumenthal said.

Patients should work closely with their doctors to establish their risk for bleeding. That risk rises as one ages or develops kidney disease, heart disease, diabetes and high blood pressure. A history of ulcers or bleeding, especially in the gastrointestinal tract, or anemia is also a risk factor. Certain medications, such as nonsteroidal anti-inflammatory drugs, steroids, direct oral anticoagulants and warfarin, a blood thinner, can also increase the chance of bleeding.

The guidelines stress that statins -- along with lifestyle changes such as a heart-healthy diet, regular exercise, weight loss and avoiding smoking or vaping tobacco -- should be used to prevent heart disease in anyone with LDL levels of more than 190 milligrams per deciliter. LDL stands for low-density lipoprotein and is the "bad" cholesterol that clogs arteries and leads to heart disease.

Changing Type 2 diabetes recommendations

Type 2 diabetes is a primary risk factor for cardiovascular disease, and the 2019 guidelines stress a diet, exercise and weight control plan as the first line of offense. Strive for at least 150 minutes a week of moderate-intensity exercise, such as brisk walking and swimming, the guidelines say. Then tack on another 75 minutes of high-intensity exercise, such as running and circuit training.

First-line medication should include metformin, the guidelines say. If additional medications are needed, two new classes of medications are showing promise in reducing cardiovascular events in those with Type 2 diabetes: SGLT-2 inhibitors, which work to increase glucose and sodium removal via the kidneys and GLP-1R agonists, which increase insulin and glucose production in the liver.

New research on these two classes of diabetes medications shows that they can also cut the risk of heart attack, stroke and related deaths, the guidelines say.


How to Follow the New Advice on Daily Aspirin

by Hallie Levine, AARP, March 26, 2019 | Comments: 0

CHARLES GATEWOOD/GETTY IMAGES

En español | More than half of all adults between the ages of 45 and 75 report taking an aspirin every day, according to a 2015 study published in the American Journal of Preventive Medicine. And for years doctors have recommended an aspirin a day for otherwise healthy older adults to help keep heart attacks at bay. Within the past year, however, the thinking has changed dramatically, says Leslie Cho, M.D., section head for preventive cardiology and cardiac rehabilitation at the Cleveland Clinic.

“The trials that established aspirin for primary prevention were done way before we had high-potent medications to help lower cholesterol, like statins,” she explains. “Now, newer research shows that the risks for most people probably outweigh the benefits.” A study funded by the National Institutes of Health of more than 19,000 people over age 70, published last year in The New England Journal of Medicine, found that a daily aspirin didn’t reduce the risk of heart attack, dementia or stroke but did increase rates of GI bleeding by an alarming 38 percent. And earlier this month, the American College of Cardiology published new guidelines recommending against routinely giving aspirin to older adults who don't have a history of heart disease.

But there are still some people who need to take an aspirin every day. “Patients have been calling nonstop over the last week, confused as to whether or not they still need to take their aspirin,” says Nieca Goldberg, a cardiologist at New York University and director of the NYU Langone Joan H. Tisch Center for Women's Health. Here’s what you need to know.

Do take a daily aspirin if you’ve already had a heart attack or stroke or have existing heart disease. “ In these people there’s clear evidence that it significantly lowers their risk of a second cardiovascular event,” Goldberg explains. This is because aspirin is an antiplatelet medication, which means it prevents your platelets from clumping together and forming blood clots that can trigger a heart attack or stroke. You also need aspirin if you already have heart disease. “You may not have been hospitalized for heart surgery, for example, but if you’ve had a coronary calcium scan and there’s plaque in your arteries, then you’re considered to have heart disease,” she says. In these cases you’ll still benefit from aspirin.

Don't take a daily aspirin if you’re over 70 and don't have heart disease (including a past heart attack or stroke). People in this group have a much higher risk of GI bleeding than younger individuals, says Cho, so it’s not likely that they’ll see much benefit. A 2017 study published in The Lancet found the risk of potentially life-threatening GI bleeding was highest in those over age 75.

Also important: Don’t stop taking a daily aspirin cold turkey. It can create a rebound effect that can trigger a heart attack, especially if you’ve already suffered one before. A 2017 Swedish study, published in the journal Circulation, found that abruptly stopping a daily aspirin raised the risk of a heart attack or stroke by 37 percent.

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Do
consider a daily aspirin if you’re between the ages of 40 and 70 and have clear risk factors for heart disease. This includes anyone who is having a hard time getting blood pressure or cholesterol under control, even with medication, or has poorly controlled diabetes, Cho says. You may also want to consider regularly taking aspirin if you have a very strong family history — that means having a father, grandfather or brother who was diagnosed with heart disease before age 55, or a mother, grandmother or sister who was diagnosed before age 65. “You’re not at increased risk if your mother had heart disease at age 80 — that’s just due to old age,” Cho notes.

Don't consider a daily aspirin if you have a history of GI bleeding or a history of ulcers, even if you have some of the above risk factors. You and your doctor should look at other ways to lower your heart disease risk, says Cho, like weight loss, a healthy diet, and keeping other conditions, such as high blood pressure or diabetes, under control.

If you are already taking aspirin (or are considering starting it), there are steps you can take to reduce the risk of GI bleeding, Cho adds. These include taking a coated aspirin, which is less likely to cause stomach irritation and thus trigger a bleed, and always taking the drug with a meal or a hearty snack. To further limit risk, your doctor will usually recommend taking the lowest dose possible, which is usually 81 mg. You should also limit your use of ibuprofen and other nonsteroidal anti-inflammatories (NSAIDs), as these can increase stomach bleeding. (If you must take one, check with your physician first — most recommend waiting at least two hours after you’ve taken an aspirin.) It’s a good idea to avoid supplements that increase your bleeding risk, such as omega-3 fatty acids (fish oil) and evening primrose oil.

If you notice symptoms of a GI bleed — namely, black, tarry bowel movements or blood in your stool — see your doctor immediately. If you’re taking aspirin daily, Cho says, your physician should be running periodic lab tests on you to check for bleeding, including tests for anemia.


2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

The following are key perspectives from the 2019 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Primary Prevention of Cardiovascular Disease (CVD):

Scope of Guideline

  1. The guideline is a compilation of the most important studies and guidelines for atherosclerotic CVD (ASCVD) outcomes related to nine topic areas. The focus is primary prevention in adults to reduce the risk of ASCVD (acute coronary syndromes, myocardial infarction, stable or unstable angina, arterial revascularization, stroke/transient ischemic attack, peripheral arterial disease), as well as heart failure and atrial fibrillation. The guideline emphasizes patient-physician shared decisions with a multidisciplinary team-based approach to the implementation of recommended preventive strategies with sensitivities to the social determinants of health that may include specific barriers to care, limited health literacy, financial distress, cultural influences, education level, and other socioeconomic risk factors related to short- and long-term health goals.

Assessment of ASCVD Risk

  1. Assessment of ASCVD risk is the foundation of primary prevention. For those aged 20-39 years, it is reasonable to measure traditional risk factors every 4-6 years to identify major factors (e.g., tobacco, dyslipidemia, family history of premature ASCVD, chronic inflammatory diseases, hypertension, or type 2 diabetes mellitus [T2DM]) that provide rationale for optimizing lifestyle and tracking risk factor progression and need for treatment. For adults aged 20-39 years and those aged 40-59 years who are not already at elevated (≥7.5%) 10-year risk, estimating a lifetime or 30-year risk for ASCVD may be considered (ASCVD Risk Estimator Plus). For those aged 20-59 years not at high short-term risk, the 30-year and lifetime risk would be reasons for a communication strategy for reinforcing adherence to lifestyle recommendations and for some drug therapy (e.g., familial hypercholesterolemia, hypertension, prediabetes, family history of premature ASCVD with dyslipidemia or elevated lipoprotein [a] Lp[a]).

Estimating Risk of ASCVD

    Electronic and paper chart risk estimators are available that utilize population-based and clinical trial outcomes with the goal of matching need and intensity of preventive therapies to absolute risk (generally 10 years) for ASCVD events. The guideline suggests the race- and sex-specific Pooled Cohort Equation (PCE) (ASCVD Risk Estimator Plus) to estimate 10-year ASCVD risk for asymptomatic adults aged 40-79 years. Adults should be categorized into low (<5%), borderline (5 to <7.5%), intermediate (≥7.5 to <20%), or high (≥20%) 10-year risk. The PCEs are best validated among non-Hispanic whites and non-Hispanic blacks living in the United States. In other race/ethnic groups and some non-US populations, the PCE may over- or under-estimate risk (e.g., HIV infection, chronic inflammatory or autoimmune disease, and low socioeconomic levels). Consideration should be given to use of other risk prediction tools if validated in a population with similar characteristics. Examples include the general Framingham CVD risk score, Reynolds risk score, SCORE, and QRISK/JBS3 tools. Among borderline and intermediate-risk adults, one may consider additional individual "risk-enhancing" clinical factors that can be used to revise the 10-year ASCVD risk estimate. For initiating or intensifying statin therapy, include: family history of premature ASCVD (men <55 years, women <65 years) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dl or non-high-density lipoprotein cholesterol (non-HDL-C) ≥190 mg/dl chronic kidney disease (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m 2 ) metabolic syndrome pre-eclampsia and premature menopause (<40 years) inflammatory diseases including rheumatoid arthritis, lupus, psoriasis, HIV South Asian ancestry biomarkers including fasting triglycerides ≥175 mg/dl, Lp(a) ≥50 mg/dl, high-sensitivity C-reactive protein ≥2 mg/L, apolipoprotein B >130 mg/dl, and ankle-brachial index (ABI) <0.9. After considering these clinically available risk-enhancing factors, if there is still uncertainty about the reliability of the risk estimate for individuals in the borderline or intermediate-risk categories, further testing to document subclinical coronary atherosclerosis with computed tomography-derived coronary artery calcium score (CACs) is reasonable to more accurately reclassify the risk estimate upward or downward.

  1. Dietary patterns associated with CVD mortality include—sugar, low-calorie sweeteners, high-carbohydrate diets, low-carbohydrate diets, refined grains, trans fat, saturated fat, sodium, red meat, and processed red meat (such as bacon, salami, ham, hot dogs, and sausage). All adults should consume a healthy plant-based or Mediterranean-like diet high in vegetables, fruits, nuts, whole grains, lean vegetable or animal protein (preferably fish), and vegetable fiber, which has been shown to lower the risk of all-cause mortality compared to control or standard diet. Longstanding dietary patterns that focus on low intake of carbohydrates and a high intake of animal fat and protein as well as high carbohydrate diets are associated with increased cardiac and noncardiac mortality. The increased availability of affordable, palatable, and high-calorie foods along with decreased physical demands of many jobs have fueled the epidemic of obesity and the consequent increases in hypertension and T2DM.
  1. Adults diagnosed as obese (body mass index [BMI] ≥30 kg/m 2 ) or overweight (BMI 25-29.9 kg/m 2 ) are at increased risk of ASCVD, heart failure, and atrial fibrillation compared with those of a normal weight. Obese and overweight adults are advised to participate in comprehensive lifestyle programs for 6 months that assist participants in adhering to a low-calorie diet (decrease by 500 kcal or 800-1500 kcal/day) and high levels of physical activity (200-300 minutes/week). Clinically meaningful weight loss (≥5% initial weight) is associated with improvement in blood pressure (BP), LDL-C, triglycerides, and glucose levels among obese or overweight individuals, and delays the development of T2DM. In addition to diet and exercise, FDA-approved pharmacologic therapies and bariatric surgery may have a role for weight loss in select patients.

Physical Activity

  1. Despite the public health emphasis for regular exercise based on extensive observational data that aerobic physical activity lowers ASCVD, approximately 50% of adults in the United States do not meet minimum recommendations. There is a strong inverse dose-response relationship between the amount of moderate-to-vigorous physical activity and incident ASCVD events and mortality. Adults should engage in at least 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous-intensity physical activity including resistance exercise.

    T2DM, defined as a hemoglobin A1c (HbA1c) >6.5%, is a metabolic disorder characterized by insulin resistance leading to hyperglycemia. The development and progression are heavily influenced by dietary pattern, physical activity, and body weight. All with T2DM should undergo dietary counseling for a heart-healthy diet that in T2DM lowers CVD events and CVD mortality. Among options include the Mediterranean, DASH, and vegetarian/vegan diets that achieve weight loss and improve glycemic control. At least 150 minutes/week of moderate to vigorous physical activity (aerobic and resistance) in T2DM lowers HbA1c about 0.7% with an additional similar decrease by weight loss. Other risk factors should be identified and treated aggressively. For younger individuals, or those with a mildly elevated HbA1c at the time of diagnosis of T2DM, clinicians can consider a trial of lifestyle therapies for 3-6 months before drug therapy.

  1. Primary ASCVD prevention requires assessing risk factors beginning in childhood. For those <19 years of age with familial hypercholesterolemia, a statin is indicated. For young adults (ages 20-39 years), priority should be given to estimating lifetime risk and promoting a healthy lifestyle. Statin should be considered in those with a family history of premature ASCVD and LDL-C ≥160 mg/dl. ASCVD risk-enhancing factors, (see risk estimate section), should be considered in all patients.

Statin Treatment Recommendations

  1. The following are guideline recommendations for statin treatment:
    • Patients ages 20-75 years and LDL-C ≥190 mg/dl, use high-intensity statin without risk assessment.
    • T2DM and age 40-75 years, use moderate-intensity statin and risk estimate to consider high-intensity statins. Risk-enhancers in diabetics include ≥10 years for T2DM and 20 years for type 1 DM, ≥30 mcg albumin/mg creatinine, eGFR <60 ml/min/1.73 m 2 , retinopathy, neuropathy, ABI <0.9. In those with multiple ASCVD risk factors, consider high-intensity statin with aim of lowering LDL-C by 50% or more.
    • Age >75 years, clinical assessment and risk discussion.
    • Age 40-75 years and LDL-C ≥70 mg/dl and <190 mg/dl without diabetes, use the risk estimator that best fits the patient and risk-enhancing factors to decide intensity of statin.
      • Risk 5% to <7.5% (borderline risk). Risk discussion: if risk-enhancing factors are present, discuss moderate-intensity statin and consider coronary CACs in select cases.
      • Risk ≥7.5-20% (intermediate risk). Risk discussion: use moderate-intensity statins and increase to high-intensity with risk enhancers. Option of CACs to risk stratify if there is uncertainty about risk. If CAC = 0, can avoid statins and repeat CAC in the future (5-10 years), the exceptions being high-risk conditions such as diabetes, family history of premature CHD, and smoking. If CACs 1-100, it is reasonable to initiate moderate-intensity statin for persons ≥55 years. If CAC >100 or 75th percentile or higher, use statin at any age.
      • Risk ≥20% (high risk). Risk discussion to initiate high-intensity statin to reduce LDL-C by ≥50%.
    Both moderate- and high-intensity statin therapy reduce ASCVD risk, but a greater reduction in LDL-C is associated with a greater reduction in ASCVD outcomes. The dose response and tolerance should be assessed in about 6-8 weeks. If LDL-C reduction is adequate (≥30% reduction with intermediate- and 50% with high-intensity statins), regular interval monitoring of risk factors and compliance with statin therapy are necessary to determine adherence and adequacy of effect (about 1 year). For patients aged >75 years, assessment of risk status and a clinician-patient risk discussion are needed to decide whether to continue or initiate statin treatment. The CACs may help refine ASCVD risk estimates among lower-risk women (<7.5%) and younger adults (<45 years), particularly in the setting of risk enhancers.

Hypertension

    In the United States, hypertension accounts for more ASCVD deaths than any other modifiable risk factor. The prevalence of stage I hypertension defined as systolic BP (SBP) ≥130 or diastolic BP (DBP) ≥80 mm Hg among US adults is 46%, higher in blacks, Asians, and Hispanic Americans, and increases dramatically with increasing age. A meta-analysis of 61 prospective studies observed a log-linear association between SBP levels <115 to >180 mm Hg and DBP levels <75 to 105 mm Hg and risk of ASCVD. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease. An increased risk of ASCVD is associated with higher SBP and SBP has been reported across a broad age spectrum, from 30 to >80 years of age.

    Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Smoking and smokeless tobacco (e.g., chewing tobacco) increases the risk for all-cause mortality and causal for ASCVD. Secondhand smoke is a cause of ASCVD and stroke, and almost one third of CHD deaths are attributable to smoking and exposure to secondhand smoke. Even low levels of smoking increase risks of acute myocardial infarction thus, reducing the number of cigarettes per day does not totally eliminate risk. Electronic Nicotine Delivery Systems (ENDS), known as e-cigarettes and vaping, are a new class of tobacco products that emit aerosol containing fine and ultrafine particulates, nicotine, and toxic gases that may increase risk for CV and pulmonary diseases. Arrhythmias and hypertension with e-cigarette use have been reported. Chronic use is associated with persistent increases in oxidative stress and sympathetic stimulation in the healthy young.

  1. For decades, low-dose aspirin (75-100 mg with US 81 mg/day) has been widely administered for ASCVD prevention. By irreversibly inhibiting platelet function, aspirin reduces risk of atherothrombosis but at the risk of bleeding, particularly in the gastrointestinal (GI) tract. Aspirin is well established for secondary prevention of ASCVD and is widely recommended for this indication, but recent studies have shown that in the modern era, aspirin should not be used in the routine primary prevention of ASCVD due to lack of net benefit. Most important is to avoid aspirin in persons with increased risk of bleeding including a history of GI bleeding or peptic ulcer disease, bleeding from other sites, age >70 years, thrombocytopenia, coagulopathy, chronic kidney disease, and concurrent use of nonsteroidal anti-inflammatory drugs, steroids, and anticoagulants. The following are recommendations based on meta-analysis and three recent trials:
    • Low-dose aspirin might be considered for primary prevention of ASCVD in select higher ASCVD adults aged 40-70 years who are not at increased bleeding risk.
    • Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults >70 years.
    • Low-dose aspirin should not be administered for primary prevention among adults at any age who are at increased bleeding risk.

Keywords: ACC Annual Scientific Session, ACC19, Aspirin, Atherosclerosis, Atrial Fibrillation, Bariatric Surgery, Blood Pressure, Cholesterol, LDL, Coronary Disease, Diabetes Mellitus, Type 2, Diet, Dyslipidemias, Exercise, Heart Failure, HIV, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Hyperglycemia, Hypertension, Inflammation, Kidney Failure, Chronic, Lipids, Lipoproteins, Metabolic Syndrome X, Metformin, Myocardial Infarction, Obesity, Plaque, Atherosclerotic, Pre-Eclampsia, Primary Prevention, Risk Factors, Smoking, Stroke, Tobacco, Triglycerides, Weight Loss


Daily low-dose aspirin no longer recommended as heart attack preventative for older adults

WASHINGTON — If you’re a healthy older adult looking for ways to reduce your risk of heart attack and stroke, don’t turn to that age-old standby: daily low-dose aspirin. It’s no longer recommended as a preventative for older adults who don’t have a high risk or existing heart disease, according to guidelines announced Sunday by the American College of Cardiology and the American Heart Association.

“For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol,” said North Carolina cardiologist Dr. Kevin Campbell, who wasn’t involved in the new guidelines. “This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention.”

Doctors may consider aspirin for certain older high-risk patients, such as those who have trouble lowering their cholesterol or managing their blood sugars, as long as there is no increased risk for internal bleeding, the guidelines say. European guidelines recommend against the use of anti-clotting therapies such as aspirin at any age.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” John Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the new guidelines, said in a statement. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin.”

Using aspirin in younger age groups “is now a class 2b recommendation,” Campbell said, “meaning that it is not necessarily the best course of action there is much debate among experts, and the data is not definitive.”

However, personally, 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.”

However, for anyone who has had a stroke, heart attack, open-heart surgery or stents inserted to open clogged arteries, aspirin can be life-saving.

“Ultimately, we must individualize treatment for each patient, based on their individual situation,” Campbell said.

New research on aspirin

Three recent studies found that taking a daily low-dose aspirin is, at best, a waste of money for healthy older adults. At worst, it may raise their risk of internal bleeding and early death.

“Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding,” Blumenthal said.

Patients should work closely with their doctors to establish their risk for bleeding. That risk rises as one ages or develops kidney disease, heart disease, diabetes and high blood pressure. A history of ulcers or bleeding, especially in the gastrointestinal tract, or anemia is also a risk factor. Certain medications, such as nonsteroidal anti-inflammatory drugs, steroids, direct oral anticoagulants and warfarin, a blood thinner, can also increase the chance of bleeding.

The guidelines stress that statins — along with lifestyle changes such as a heart-healthy diet, regular exercise, weight loss and avoiding smoking or vaping tobacco — should be used to prevent heart disease in anyone with LDL levels of more than 190 milligrams per deciliter. LDL stands for low-density lipoprotein and is the “bad” cholesterol that clogs arteries and leads to heart disease.

Changing Type 2 diabetes recommendations

Type 2 diabetes is a primary risk factor for cardiovascular disease, and the 2019 guidelines stress a diet, exercise and weight control plan as the first line of offense. Strive for at least 150 minutes a week of moderate-intensity exercise, such as brisk walking and swimming, the guidelines say. Then tack on another 75 minutes of high-intensity exercise, such as running and circuit training.

First-line medication should include metformin, the guidelines say. If additional medications are needed, two new classes of medications are showing promise in reducing cardiovascular events in those with Type 2 diabetes: SGLT-2 inhibitors, which work to increase glucose and sodium removal via the kidneys and GLP-1R agonists, which increase insulin and glucose production in the liver.

New research on these two classes of diabetes medications shows that they can also cut the risk of heart attack, stroke and related deaths, the guidelines say.


Don't take an aspirin a day to prevent heart attacks and strokes: Doctors reverse recommendation

A daily low-dose aspirin has been touted by many doctors in preventing heart attacks. But a new study suggests that it might do more harm than good. USA TODAY

Taking a low-dose aspirin every day to prevent a heart attack or stroke is no longer recommended for most older adults, according to guidelines released Sunday.

After doctors said for decades that a daily 75 to 100 milligrams of aspirin could prevent cardiovascular problems, the American College of Cardiology and the American Heart Association reversed that idea.

A large clinical trial found a daily low-dose aspirin had no effect on prolonging life in healthy, elderly people and actually suggested the pills could be linked to major hemorrhages.

Sunday's recommendations say low-dose aspirin should not be given to prevent atherosclerotic cardiovascular disease on a routine basis to adults older than 70 or any adult at an increased risk of bleeding.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” cardiologist Roger Blumenthal said in a statement. "It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin."

Only select people with a high risk of cardiovascular disease and low risk of bleeding might continue using the painkiller as a preventive measure, as told by their doctor, Blumenthal said.

The ACC and AHA say regular exercise, maintaining a healthy weight, avoiding tobacco and eating a diet rich in vegetables and low in sugar and trans fats are among the best ways to prevent cardiovascular disease.


Related Links

References:
Effect of Aspirin on Disability-free Survival in the Healthy Elderly. McNeil JJ, Woods RL, Nelson MR, Reid CM, Kirpach B, Wolfe R, Storey E, Shah RC, Lockery JE, Tonkin AM, Newman AB, Williamson JD, Margolis KL, Ernst ME, Abhayaratna WP, Stocks N, Fitzgerald SM, Orchard SG, Trevaks RE, Beilin LJ, Donnan GA, Gibbs P, Johnston CI, Ryan J, Radziszewska B, Grimm R, Murray AM ASPREE Investigator Group. N Engl J Med. 2018 Sep 16. doi: 10.1056/NEJMoa1800722. [Epub ahead of print]. PMID: 30221596.

Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, Reid CM, Lockery JE, Kirpach B, Storey E, Shah RC, Williamson JD, Margolis KL, Ernst ME, Abhayaratna WP, Stocks N, Fitzgerald SM, Orchard SG, Trevaks RE, Beilin LJ, Johnston CI, Ryan J, Radziszewska B, Jelinek M, Malik M, Eaton CB, Brauer D, Cloud G, Wood EM, Mahady SE, Satterfield S, Grimm R, Murray AM ASPREE Investigator Group. N Engl J Med. 2018 Sep 16. doi: 10.1056/NEJMoa1805819. [Epub ahead of print]. PMID: 30221597.

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. McNeil JJ, Nelson MR, Woods RL, Lockery JE, Wolfe R, Reid CM, Kirpach B, Shah RC, Ives DG, Storey E, Ryan J, Tonkin AM, Newman AB, Williamson JD, Margolis KL, Ernst ME, Abhayaratna WP, Stocks N, Fitzgerald SM, Orchard SG, Trevaks RE, Beilin LJ, Donnan GA, Gibbs P, Johnston CI, Radziszewska B, Grimm R, Murray AM ASPREE Investigator Group. N Engl J Med. 2018 Sep 16. doi: 10.1056/NEJMoa1803955. [Epub ahead of print]. PMID: 30221595.

Funding: NIH’s National Institute on Aging (NIA) and National Cancer Institute (NCI) National Health and Medical Research Council of Australia Monash University and Victorian Cancer Agency.


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If you’re a healthy older adult looking for ways to reduce your risk of heart attack and stroke, don’t turn to that age-old standby: daily low-dose aspirin. It’s no longer recommended as a preventative for older adults who don’t have a high risk or existing heart disease, according to guidelines announced Sunday by the American College of Cardiology and the American Heart Association.

“For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol,” said North Carolina cardiologist Dr. Kevin Campbell, who wasn’t involved in the new guidelines. “This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention.”

Doctors may consider aspirin for certain older high-risk patients, such as those who have trouble lowering their cholesterol or managing their blood sugars, as long as there is no increased risk for internal bleeding, the guidelines say. European guidelines recommend against the use of anti-clotting therapies such as aspirin at any age.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” John Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the new guidelines, said in a statement. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin.”

Using aspirin in younger age groups “is now a class 2b recommendation,” Campbell said, “meaning that it is not necessarily the best course of action there is much debate among experts, and the data is not definitive.”

However, personally, 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.”

However, for anyone who has had a stroke, heart attack, open-heart surgery or stents inserted to open clogged arteries, aspirin can be life-saving.

“Ultimately, we must individualize treatment for each patient, based on their individual situation,” Campbell said.

New research on aspirin

Three recent studies found that taking a daily low-dose aspirin is, at best, a waste of money for healthy older adults. At worst, it may raise their risk of internal bleeding and early death.

“Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding,” Blumenthal said.

Patients should work closely with their doctors to establish their risk for bleeding. That risk rises as one ages or develops kidney disease, heart disease, diabetes and high blood pressure. A history of ulcers or bleeding, especially in the gastrointestinal tract, or anemia is also a risk factor. Certain medications, such as nonsteroidal anti-inflammatory drugs, steroids, direct oral anticoagulants and warfarin, a blood thinner, can also increase the chance of bleeding.

The guidelines stress that statins — along with lifestyle changes such as a heart-healthy diet, regular exercise, weight loss and avoiding smoking or vaping tobacco — should be used to prevent heart disease in anyone with LDL levels of more than 190 milligrams per deciliter. LDL stands for low-density lipoprotein and is the “bad” cholesterol that clogs arteries and leads to heart disease.

Changing Type 2 diabetes recommendations

Type 2 diabetes is a primary risk factor for cardiovascular disease, and the 2019 guidelines stress a diet, exercise and weight control plan as the first line of offense. Strive for at least 150 minutes a week of moderate-intensity exercise, such as brisk walking and swimming, the guidelines say. Then tack on another 75 minutes of high-intensity exercise, such as running and circuit training.

First-line medication should include metformin, the guidelines say. If additional medications are needed, two new classes of medications are showing promise in reducing cardiovascular events in those with Type 2 diabetes: SGLT-2 inhibitors, which work to increase glucose and sodium removal via the kidneys and GLP-1R agonists, which increase insulin and glucose production in the liver.

New research on these two classes of diabetes medications shows that they can also cut the risk of heart attack, stroke and related deaths, the guidelines say.


Daily Aspirin No Longer Recommended to Help Prevent Heart Attacks for Healthy Adults

Historically, Aspirin was used to help prevent heart attacks or strokes in the elderly population.
And now, studies from the American College of Cardiology and American Heart Association say the benefits may not outweigh the risks for those with no history of heart disease.

“The risk associated, as far as internal bleeding on Aspirin, is actually more significant than any benefit that you would actually have on Aspirin without necessarily having established heart disease,” said Dr. Simone Fearon at Thedacare’s Cardiovascular Institute.

This mostly affects the elderly population with no history of heart attacks or strokes.

“If you’re considered low risk or moderate risk, you may not need to be on it,” she said. “So why take a drug if you don’t need to be on it?”

A healthy lifestyle, managing your blood pressure, and minimizing your exposure to pollution like cigarette smoke are the best solutions for low-risk patients.
But, as always, if you aren’t sure–talk to an expert.

“Make a point to have a conversation with your doctor before making any changes,” said Dr. Fearon.

For a closer look at the new recommendations, check here.

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


Daily low-dose aspirin no longer recommended as heart attack preventative for older adults

If you're a healthy older adult looking for ways to reduce your risk of heart attack and stroke, don't turn to that age-old standby: daily low-dose aspirin. It's no longer recommended as a preventative for older adults who don't have a high risk or existing heart disease, according to guidelines announced Sunday by the American College of Cardiology and the American Heart Association.

"For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol," said North Carolina cardiologist Dr. Kevin Campbell, who wasn't involved in the new guidelines. "This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention."

Doctors may consider aspirin for certain older high-risk patients, such as those who have trouble lowering their cholesterol or managing their blood sugars, as long as there is no increased risk for internal bleeding, the guidelines say. European guidelines recommend against the use of anti-clotting therapies such as aspirin at any age.

"Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease," John Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the new guidelines, said in a statement. "It's much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin."

Using aspirin in younger age groups "is now a class 2b recommendation," Campbell said, "meaning that it is not necessarily the best course of action there is much debate among experts, and the data is not definitive."

However, personally, 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."

However, for anyone who has had a stroke, heart attack, open-heart surgery or stents inserted to open clogged arteries, aspirin can be life-saving.

"Ultimately, we must individualize treatment for each patient, based on their individual situation," Campbell said.

New research on aspirin

Three recent studies found that taking a daily low-dose aspirin is, at best, a waste of money for healthy older adults. At worst, it may raise their risk of internal bleeding and early death.

"Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding," Blumenthal said.

Patients should work closely with their doctors to establish their risk for bleeding. That risk rises as one ages or develops kidney disease, heart disease, diabetes and high blood pressure. A history of ulcers or bleeding, especially in the gastrointestinal tract, or anemia is also a risk factor. Certain medications, such as nonsteroidal anti-inflammatory drugs, steroids, direct oral anticoagulants and warfarin, a blood thinner, can also increase the chance of bleeding.

The guidelines stress that statins -- along with lifestyle changes such as a heart-healthy diet, regular exercise, weight loss and avoiding smoking or vaping tobacco -- should be used to prevent heart disease in anyone with LDL levels of more than 190 milligrams per deciliter. LDL stands for low-density lipoprotein and is the "bad" cholesterol that clogs arteries and leads to heart disease.

Changing Type 2 diabetes recommendations

Type 2 diabetes is a primary risk factor for cardiovascular disease, and the 2019 guidelines stress a diet, exercise and weight control plan as the first line of offense. Strive for at least 150 minutes a week of moderate-intensity exercise, such as brisk walking and swimming, the guidelines say. Then tack on another 75 minutes of high-intensity exercise, such as running and circuit training.

First-line medication should include metformin, the guidelines say. If additional medications are needed, two new classes of medications are showing promise in reducing cardiovascular events in those with Type 2 diabetes: SGLT-2 inhibitors, which work to increase glucose and sodium removal via the kidneys and GLP-1R agonists, which increase insulin and glucose production in the liver.

New research on these two classes of diabetes medications shows that they can also cut the risk of heart attack, stroke and related deaths, the guidelines say.



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