{"id":4881,"date":"2021-10-24T13:48:06","date_gmt":"2021-10-24T13:48:06","guid":{"rendered":"https:\/\/drmirkin.com\/?p=4881"},"modified":"2021-10-24T13:48:06","modified_gmt":"2021-10-24T13:48:06","slug":"new-guidelines-on-aspirin-for-heart-attack-prevention","status":"publish","type":"post","link":"http:\/\/drmirkin.com\/?p=4881","title":{"rendered":"New Guidelines on Aspirin for Heart Attack Prevention"},"content":{"rendered":"\n

Daily\naspirin can help to prevent heart attacks, but the United States Preventive\nServices Task Force now recommends that:
\n\u2022 adults 60 years and older should not take aspirin to help prevent a first\nheart attack, and
\n\u2022 those 40-59 years old who are at high risk for heart disease should take\naspirin only on their doctor\u2019s recommendation (USPSTF<\/em>, October\n12, 2021).<\/p>\n\n\n\n

Taking\naspirin daily will reduce clotting, which may help to prevent a heart attack,\nbut it can increase risk for internal bleeding into the brain to cause a stroke\nor into the stomach to cause bleeding ulcers. The USPSTF message is that people\nover 60 are more likely to die from bleeding than they are to be protected from\nsuffering a heart attack. However, there is some data to show that daily\naspirin may be beneficial in high-risk 40 to 59-year-old people, who are more\nlikely to be protected from a heart attack than they are to be harmed by\nbleeding into the brain.<\/p>\n\n\n\n

If you are\nalready taking aspirin, you should not stop taking it until you have discussed\nyour case with your doctor. Those who have already had a heart attack, stroke,\na coronary artery stent, or coronary artery bypass graft surgery may benefit\nfrom taking aspirin regularly (JAMA<\/em>, 2020;323(7):676). Everyone who\nis at increased risk for a heart attack should talk with their physician and\njointly decide if they should take aspirin.<\/p>\n\n\n\n

The Data<\/strong>
\nThe USPSTF’s recommendations are based on their review of 13 studies on nearly\n165,000 adults, with a mean age of 62 and without heart disease. These studies\nshowed that five years of taking aspirin every day increased nearly the same\npercentage of major bleeding episodes as it reduced the incidence of heart\nattacks (JAMA<\/em>, Jan 22, 2019;321(3):277-287).<\/p>\n\n\n\n

Other\nstudies have shown that the number of diabetic lives saved from heart attacks\nand clotting strokes was offset by the number of diabetics who died from major bleeding\ninto the brain, eyes, stomach, and other places (N Engl J Med<\/em>,\nOct 18, 2018; 379:1529-1539). Diabetes is among the strongest risk factors for\nsuffering heart attacks in North America today with more than 68 percent of\nType II diabetics dying from some form of heart disease and 16 percent dying of\nstrokes.<\/p>\n\n\n\n

Taking\naspirin daily for three years was associated with a reduction in heart attacks\nin people who had previous heart attacks, but not in those who had not had a\nprevious heart attack (Clin Cardiol<\/em>, May 2017; Am J Med<\/em>,\n2015 Feb;128(2):137-43). The American Heart Association (AHA) has previously\nrecommended taking daily aspirin only if your chance of developing a heart\nattack in the next 10 years is greater than five percent (Ann\nIntern Med<\/em>, June 21, 2016;164(12):826-35).<\/p>\n\n\n\n

Heart Attacks Are Caused By Clotting<\/strong>
\nCardiovascular disease is the leading cause of death in the U.S., affecting\n600,000 people each year or about one in every three deaths. Heart attacks are\nnot caused by narrowed arteries; they are caused by a plaque breaking off from\nthe inner lining of an artery leading to the heart, followed by bleeding. Then\na clot forms that completely obstructs the flow of blood to the heart muscle,\nand the part of the heart muscle that suddenly has no source of oxygen dies.\nAspirin helps to prevent this clotting, but it also increases risk of bleeding\ninto the brain or the stomach.<\/p>\n\n\n\n

Risk factors\nfor heart attacks include:
\n\u2022 smoking
\n\u2022 lack of exercise
\n\u2022 high cholesterol
\n\u2022 high blood pressure
\n\u2022 high blood sugar or diabetes
\n\u2022 being overweight
\n\u2022 abdominal obesity
\n\u2022 a pro-inflammatory\ndiet<\/a>
\n\u2022 family history of heart attacks
\n\u2022 having autoimmune or inflammatory conditions such as psoriasis, HIV,\nrheumatoid arthritis, lupus or kidney disease, which increase risk for heart\ndisease<\/p>\n\n\n\n

Tests that\nyour doctor will use to assess your risk for a heart attack include:
\n\u2022 Blood pressure >120\/80
\n\u2022 LDL cholesterol >100
\n\u2022 HDL cholesterol <40
\n\u2022 HBA1c (a test for diabetes) >5.7
\n\u2022 CRP (a marker of inflammation<\/a>)\n>1
\n\u2022 Resting heart rate >70
\n\u2022 Triglycerides >150
\n\u2022 Lp(a) (a genetic clotting condition) >130
\n\u2022 Homocysteine >10
\n\u2022 Calcium\nscore<\/a> (CT scan of arteries leading to the heart)
\n
\nFor more information, see:
\nHeart\nAttack Prevention<\/a>
\nHeart\nAttack Risk Factors<\/a>
\nStabilizing\nPlaques with Exercise and Possibly Statins<\/a><\/p>\n\n\n\n

My Recommendations<\/strong>
\nI think that using aspirin for occasional pain relief can be safe, but taking\naspirin regularly is likely to make you bleed easily, which can harm you and\neven cause death from a stroke or other internal bleeding. If you are already\ntaking aspirin daily, do not stop without consulting your doctor. He or she\nwill certainly be aware of these new guidelines and you can discuss your\nindividual situation.<\/p>\n","protected":false},"excerpt":{"rendered":"

Daily aspirin can help to prevent heart attacks, but the United States Preventive Services Task Force now recommends that:
\nadults 60 years and older should not take aspirin to help prevent a first heart attack, and those 40-59 years old who are at high risk for heart disease should take aspirin only on their doctor\u2019s recommendation<\/p>\n","protected":false},"author":1,"featured_media":1025,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[20],"tags":[422,423,1042,1043,424,1041,72],"class_list":["post-4881","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-heart","tag-aspirin","tag-baby-aspirin","tag-bleeding","tag-bleeding-stroke","tag-daily-aspirin","tag-daily-baby-aspirin","tag-heart-attacks"],"_links":{"self":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/posts\/4881","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4881"}],"version-history":[{"count":0,"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/posts\/4881\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/media\/1025"}],"wp:attachment":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4881"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4881"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4881"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}