New Daily Aspirin Recommendations: Are They for You?

Risk of internal bleeding rises with regular use

A federal panel has issued a new recommendation that some people who have never had heart disease should take a low dose of aspirin every day. But following this advice has potential risks for other health problems that should not be underestimated.

The U.S. Preventive Services Task Force (USPSTF) this week issued a recommendation that many people between the ages of 50 and 59 take aspirin to prevent heart disease and colon cancer.

This advice focuses on primary prevention — meaning it’s for people who have no known heart disease. The new USPSTF recommendations suggest prophylactic aspirin for people who:

  • Are between ages 50 and 59
  • Have a 10 percent or greater risk of developing heart disease in the next 10 years
  • Are not at an increased risk for bleeding
  • Have a life expectancy of at least 10 years

Is a low-dose daily aspirin regimen for you? You should never start an aspirin regimen without discussing it with your physician first. And there are some serious drawbacks to this approach.

Concern with bleeding

If you have heart disease — meaning you’ve had a heart attack, bypass surgery or stents — doctors agree that you should take a low dose of aspirin – about 81 mg – every day, unless your doctor determines you have a very high bleeding risk.

But many doctors do not recommend a daily aspirin for people who don’t have heart disease.

The reason is that there is increased danger of bleeding in the brain or stomach. This is true even if you take coated aspirin, because the drug reduces your blood platelets’ ability to clot.

This increased risk for internal bleeding can be life-threatening, depending on your medical history.

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“It’s important to understand that there are risks for aspirin,” says cardiologist Steven Nissen, MD. “There are risks of bleeding into the stomach and even bleeding into the brain.”

Proceed with caution

Dr. Nissen says doctors and patients need to proceed with caution with these new recommendations.

The USPSTF recommendations contradict other recent advice, such as from the Food and Drug Administration (FDA), which recently said that people without existing heart disease should not take aspirin to avoid a heart attack or stroke.

The FDA says scientists have not proven that aspirin therapy has benefits for people without cardiovascular problems. This group includes those with risk factors such as a family history of heart disease.

What if you have a heart condition?

Clinical data since the 1990s show that a daily low dose of aspirin can help prevent a re-occurrence for people who have had a heart attack, stroke or disease of the heart’s blood vessels, the FDA says.

But only a select few otherwise healthy patients benefit from aspirin therapy. Although people at extremely high risk for heart disease may benefit, others may be doing more harm than good.

You definitely should stop taking aspirin if you’re taking it without a doctor’s guidance to prevent cardiovascular problems and have no history of heart disease or heart attack, Dr. Nissen says.

“For most people who have not developed heart disease, taking an aspirin to prevent heart disease is not the right thing to do,” Dr. Nissen says.

It’s important to talk with your doctor about the benefits of daily aspirin therapy. Your doctor will be best able to calculate your risks and benefits from taking aspirin, and will take your medical history into account.

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Cleveland Clinic

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