Regina Griffith was 64 when she met her
new primary care doctor for a routine checkup. He recommended a daily low-dose
aspirin for heart health, she recalled.
اضافة اعلان
It’s hard to be more fit than Griffith, owner and
chief instructor at a fitness studio in Montclair, New Jersey. She had a
slightly elevated blood pressure at the doctor’s office (but not at home, using
her own cuff); other than that, she had no significant health problems.
Still, a daily aspirin did not seem like a big deal,
and the doctor did not mention any downsides, so she took his advice. “I
thought, ‘OK, I’m at a certain age,’” Griffith said. “It didn’t sound scary to
take aspirin.”
Millions of older Americans do likewise, and not
always because of a doctor’s recommendation. Alan Turner, 64, an industrial
designer in New Castle, Delaware, began taking aspirin on his own about five
years ago, after his mother had several strokes. “I saw what that did to her,”
he said. He had heard of other people his age taking prophylactic aspirin, so
he “just went with it,” he said. “How much damage can you do with a baby
aspirin a day?”
Good question. For three decades, the US Preventive
Services Task Force, an independent and influential panel of experts, has been
reviewing the growing evidence of aspirin use for preventing first heart
attacks and strokes.
Last month, it issued its latest recommendations on
aspirin use, the first in six years. The panel warned adults older than 60
against starting an aspirin regimen for primary prevention.
“It carries possible serious harms” — notably, an
increased risk of internal bleeding, said Dr. John Wong, a task force member.
“And those harms are higher than we thought in 2016.” Wong is a primary care
doctor and interim chief scientific officer at Tufts Medical Center in Boston.
“Primary prevention” refers to patients who have
never had a heart attack or stroke and do not have heart disease. (High blood
pressure, or hypertension, is not considered heart disease.) That group is the
task force’s focus.
People taking aspirin for secondary prevention —
because they have already had a heart attack, stroke or intervention such as
stenting or bypass surgery — face higher risk of subsequent cardiovascular
events, and aspirin might remain part of their treatment.
For adults ages 40–59, the net benefit of taking
aspirin daily would be small, the task force concluded. They may choose to
start a daily aspirin regimen if, based on widely used health calculators, they
face a 10 percent or higher risk for cardiovascular disease over the next
decade, but that should be an individual decision.
It will take time for these new cautions to trickle
down to the public. About one-third of Americans older than 40 already take
aspirin, a 2019 study found. Among those older than 70, more than 45 percent
take aspirin for primary prevention, probably representing significant overuse.
“Many people don’t even think of aspirin as
medication, they think of it as more like a vitamin,” said Dr Amit Khera,
director of preventive cardiology at the University of Texas Southwestern
Medical Center. “But just because it’s over-the-counter, doesn’t mean it’s not
a drug with benefits and risks.”
In 2019, Khera helped develop similar guidelines for
the American College of Cardiology and American Heart Association, which
recommended against routine aspirin use for primary prevention in people older
than 70. The American Geriatrics Society’s Beers Criteria, a list of
medications considered inappropriate for older patients, is also considering
recommending that “most older adults” avoid starting aspirin for primary
prevention.
The US Preventive Services Task Force’s position on
aspirin use for prevention has seesawed over the decades, noted Dr Allan Brett,
an internist at the University of Colorado, in a JAMA editorial accompanying
the new guidelines. The task force initially recommended in 1989 that patients
consider aspirin, then backed off, calling the evidence insufficient. It
encouraged preventive aspirin for many adults in 2009 but had grown more
skeptical by 2016.
What has changed this time around? Three large,
rigorous clinical trials published in 2018, following more than 47,000 older
patients, “really highlighted the risks,” Khera said.
Wong added: “Two didn’t find any significant
reductions in heart attack or stroke, but there was an increased risk of
bleeding.” The third clinical trial, which was limited to people with diabetes,
a higher-risk group, found a small reduction in cardiovascular events — but
with a higher bleeding risk. “The harm canceled out the benefit,” Wong said.
The bleeding in question usually occurs in the
gastrointestinal tract but can also include brain bleeds and hemorrhagic
strokes. Although the risks are low — major bleeding occurred in 1 percent or
fewer of older people taking aspirin in the 2018 studies — they increase with
age. “These are serious bleeds,” Brett said. “They can require transfusions.
They can put people in the hospital.”
With the advent of other effective advances in
preventing heart attacks and strokes — better blood pressure drugs, statins for
lowering cholesterol, a reduction in smoking — the role for aspirin has
narrowed, experts said.
For people older than 60, per the task force
guidelines, or 70, per the cardiologists’ recommendations, the risks of
starting aspirin now outweigh the benefits. This is particularly true for
people with a history of bleeding, say from ulcers or aneurysms, or those
taking medications such as blood thinners, steroids or anti-inflammatories such
as ibuprofen or naproxen.
Griffith, now 65, recently saw a different doctor in
her new primary care practice. The doctor looked at her chart, which showed no
heart disease and more than a year of aspirin use.
“He said, ‘I don’t think you need to do that,’” she
said.
Griffith had already begun to question the practice and had
cut back to an aspirin every other day. Now, she’s going to stop.
Read more Health
Jordan News
.jpg)
.jpg)
