The USPSTF says there are more risks than benefits of daily aspirin use

A new recommendation from public health experts in the United States considers that widely used aspirin could be risky. Why? We analyze it.

Last update: October 22, 2021

The US Preventive Services Task Force (USPSTF) just raised that the risks outweigh the benefits of using aspirin every day. This has raised a series of doubts in the general population, since there are many who consume the drug on a regular basis as a way to prevent cerebrovascular and cardiovascular accidents.

The new USPSTF recommendation has been published on October 12 of this year and is in a state in progress until November 8. This means that, for now, it is an opinion of public health experts in the United States that will be supplemented with comments that other professionals may make.

This process will close on November 8, 2021 and there, finally, the United States public health area will issue a verdict. Based on these new recommendations and the comments gathered by the deadline, a new aspirin use guide will be published.

What is a daily aspirin usually prescribed for?

Aspirin is the name for acetylsalicylic acid. This substance works within the human body as an anti-inflammatory, pain reliever and fever reducer in a timely manner. But if the dose is varied and reduced, there is an antiplatelet effect that was intended to be used to reduce the risk of thrombus formation.

That is, with a daily dose of less than 325 milligrams (the usual dose is more than 500 milligrams for other disorders) the aggregating action of platelets is blocked. If platelets cannot aggregate (bond together) there is less risk of clots forming within arteries that are narrowed or smaller (from the deposit of atheroma plaques, for example).

It had been established that the most effective daily dose of aspirin to prevent blood clots is 81 milligrams per day. This quantity is known as baby aspirin in English and is prescribed by professionals to prevent strokes and heart attacks. The most common commercial presentation in pharmacies is that of 100-milligram tablets, which is why it is usually the most prescribed form for this purpose.

Although it was always uncontroversial that people who have already suffered an acute myocardial infarction, for example, take their minimum daily dose of aspirin, with other patients there was no uniformity of criteria. In recent decades, it has been debated whether a person without a cardiac or cerebrovascular history benefited from the baby aspirin or not.

A history of acute myocardial infarction remains an indication for the use of aspirin daily.

What changes from aspirin in the new USPSTF guidelines?

The US Preventive Services Task Force It is a group of medical experts who are chosen by the director of the Agency for Research and Quality in Health of the United States, which depends on the Department of Health and Human Services of the same country. In total, there are 16 professionals who analyze the evidence to determine clinical guidelines and healthy recommendations for the population.

Having compiled scientific studies from recent years, the USPSTF states that many population groups have more risks than benefits when using daily aspirin. Based on this, they have separated their new recommendations into two parts:

  • They should not take daily aspirin: those 60 years or older who do not have a history of heart or cerebrovascular disease and who do not have stents, they should not take the dose of baby aspirin. They won’t find any long-term benefits, and they could even have serious adverse effects.
  • They could take daily aspirin if they discuss it with their doctor: Those people between 40 and 59 years old who did not have a cardiac or cerebrovascular event either, but do have risk factors for having them in the future, should meet with their GP and evaluate the pros and cons of taking aspirin on a daily basis. This group includes people with diabetes, hypertension or obesity.

As we can see, the new USPSTF recommendations on the consumption of aspirin only affect groups in which there are doubts about the benefit of taking it daily. In principle, the indications for patients who have suffered heart attacks, cerebrovascular events or underwent surgery with the placement of a stent.

Why this change?

This change proposed by the USPSTF on aspirin is based on the risks that have been registered in patients with daily use of the drug. In recent years, several reports have reported serious adverse effects arising from the use of baby aspirin.

These consequences may outweigh the benefits in population groups without a cardiovascular history.. And the biggest problem is bleeding. As aspirin is antiplatelet, it reduces the ability of platelets to block bleeding.

Internal bleeding can be very dangerous and life-threatening. When a person consumes aspirin on a daily basis and for whatever reason has a hemorrhage inside the body, the inability to clot it due to the effect of the drug would lead to massive blood loss with a clear possibility of death.

Thus, people with a higher risk of bleeding have been identified if they take aspirin on a daily basis. These include the following:

  • Those who have had internal bleeding before.
  • Those who have low levels of platelets in a laboratory test.
  • Patients with coagulation pathologies.
  • People with a positive test for occult blood in the stool.
  • Those who take non-steroidal anti-inflammatory drugs for pain, such as ibuprofen.

What alternatives are there to daily aspirin?

The prevention of cardiovascular diseases is based on lifestyle and not on pharmacology. This was already expressed in 2019 by the members of the American College of Cardiology and the American Heart Association.

This does not mean that drugs should not be prescribed to heart patients or those at risk of being so, but rather that changes in diet, reduction of sedentary lifestyle, stress control and promotion of physical exercise should be prioritized. These modifications are capable of creating an internal and external environment favorable to the reduction of cardiovascular risk.

Therefore, a person over 60 who has no history of heart attacks or strokes, instead of taking aspirin daily, should prefer sports and healthy eating. With both tools, you would be able to reduce your cardiovascular risk without taking medication.

Consideration is also important for patients with chronic painful conditions that require constant use of non-steroidal anti-inflammatory drugs. In them, if they repeatedly consume ibuprofen, for example, the risk of bleeding when adding aspirin is very high.

Therefore, it will always be convenient to lay the preventive foundations with the lifestyle. In particular cases, the medical consultation will be imposed to assess the pros and cons of aspirin.

Lifestyle habits directly influence cardiovascular health and preventive efforts should be focused there.

What do I do with the new USPSTF recommendations for aspirin?

In conclusion, when faced with the question that a person may have about what to do with the new USPSTF guidelines if they take aspirin or were thinking of starting consumption, the important thing is the following:

  • Those older than 60 years without a cardiac history should not take aspirin as a primary prevention method.
  • People between the ages of 40 and 59 with a risk factor for future heart attacks or strokes would need to consult with a doctor for the professional to determine if they would benefit of a small daily dose of aspirin.
  • Those who are already medicated with baby aspirin because they have had heart attacks or cerebrovascular events, they have to continue taking the drug according to their doctor’s guideline.

The clinical guidelines are updated according to the evidence. It is the way to protect the population from possible adverse effects. Currently, the USPSTF considers that aspirin should not be widely used and scientific studies support that recommendation.

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