Do not stop taking aspirin: Let risk factors, not age be guide for doctors' recommendations

Nicole Villalpando
Austin American-Statesman

The U.S. Preventive Services Task Force last week put out some proposed recommendations for when adults should take aspirin for heart disease prevention and when they should not.

The recommendations had many people thinking they should throw away their aspirin bottles.

That is not the case.

The task force advises that people ages 40 to 59 talk to their doctors about whether the risks of taking aspirin daily outweigh their risk of heart disease. And they recommend that people older than 60 not start aspirin to prevent heart disease. 

This does not apply to people who already have had some sort of heart disease event such as a heart attack, stroke, bypass or stent placement, said Dr. Vivek Goswami, a cardiologist with Heart Hospital of Austin and Austin Heart.

If those people stopped taking the aspirin, "it would be dangerous," he said. 

Taking a daily aspirin to prevent heart disease might still make sense for some people, but for others it could do more harm than good.

Aspirin helps prevent platelets in the blood from stacking on top of one another, which can keep them from clogging an artery or a stent that has been put in place. 

"Aspirin continues to be a very important therapy," Goswami said. 

People on an aspirin regimen who haven't yet had a cardiac event, such as heart attack, stroke, stents or bypass, shouldn't toss the bottle yet either. They should talk with their doctors about whether to continue. 

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What the recommendations are really saying is that you do not need to automatically start taking a baby aspirin every day once you hit age 50. Instead, have a conversation with your doctor about what your heart disease risk factors are. 

"This is a personalization in our medical recommendations based on individual risk factors and history," Goswami said. He sees that as a trend in a lot of recommendations recently.

For example, he could have several patients with the same cholesterol readings. For one, he might recommend preventive measures such as changing the diet; for another, he might recommend medication; and for a third, he might recommend just watching it. 

The old recommendation of an aspirin a day at age 50 or 60, he said, "is based on older data before we had better medical therapy and other preventative measures." 

Daily aspirin no longer makes sense for everyone over 50 or 60 because we have learned that aspirin might not make any difference in some people who don't have risk factors for heart disease. Aspirin also could cause bleeding problems, which is particularly problematic in people who have conditions such as ulcers, Goswami said. 

"If the benefit is very low, maybe the risks outweigh the benefit," he said. 

Alex Franco discusses the HeartSaver CT with Dr. Vivek Goswami. Deciding when to get a CT to look at the plaque in your arteries should involve a conversation with your doctor.

Doctors need to personalize the risks and the benefits before recommending aspirin, he said. 

Factors doctors consider include quality of diet including sodium intake, the amount of exercise a person does, blood pressure and cholesterol readings, and family history of cardiac events. 

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Those show only risk factors. To really see what is happening in a patient, a doctor needs to schedule a coronary CT calcium scan to see how much calcified plaque is building up in the heart arteries. 

That scan is similar to a colonoscopy to check for colon cancer and a mammogram to check for breast cancer. You don't have to wait to have symptoms to get those scans done, and earlier testing can catch problems when they are more easy to treat.

In general, getting the scan done around 45 for men and 55 for women makes sense to Goswami because that's usually before a first heart event and women tend to have heart disease 10 years later than men. 

Every person will have a different recommendation for a first baseline scan. Based on his personal risk factors and family history, Goswami had his first scan at age 35.

When it comes to a heart attack, "you don't have to just wait for that to happen" before doing something about it, Goswami said.