Aspirin may be Harmful When Used for Preventing 1st Heart Attack, Stroke

The risks of aspirin outweigh the possible benefits for heart attacks and strokes among people above the age of 60 years.

Highlights:

Heart attack and stroke are the foremost causes of death and disability respectively
Almost 5.3 million Canadian adults take aspirin for the prevention of heart disease and stroke
In contrast, new guidelines by the U.S. Preventative Services Task Force show that older adults above 60 years of age should avoid taking daily aspirin to prevent 1st heart attack or stroke
However, the guidelines do not apply to people who are already on aspirin due to prior history of heart attack or stroke

Older adults above 60 years of age should avoid taking daily aspirin to prevent first heart attack or stroke as per the draft recommendations issued by the U.S. Preventative Services Task Force.

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‘A daily dose of aspirin for heart attacks and strokes is found to cause internal bleeding in the brain and stomach among people above the age of 60 years, thereby outweighing the possible benefits of the drugs. ’
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What is a Heart Attack?

Heart attack, also known as Myocardial Infarction (MI), occurs due to any artery blockage that supplies blood and oxygen to your heart. As a result of poor oxygen, the cardiomyocytes (heart cells) start to die and end in a heart attack.

What is Stroke?

Stroke is defined as a sudden restriction of blood flow to the brain that affects its function. Certain types of stroke can even result in devastating or long-term disability to the patients.

Stroke is basically of two types:

Ischemic Stroke (due to occlusion of the blood vessels)
Hemorrhagic Stroke (due to bursting of the blood vessels)

Calculate Your Lifetime Risk of Heart Attack
Heart Risk Calculator assesses the lifetime risk for a heart attack and helps in making the right lifestyle choices to protect your heart.

What is Aspirin?

Aspirin, also known as acetylsalicylic acid or ASA, is widely used as an antiplatelet medicine to prevent and manage heart attacks or strokes – a remarkably cheaper weapon considered in the battle against vascular diseases.

The drug aids in preventing the development of blood clots in the blood vessels, thus rendering protection for both the heart and brain. It is also used to prevent various other vascular events and congenital defects.

It is estimated that ~ 5.3 million Canadian adults are on aspirin for the prevention of heart disease and stroke. Moreover, 2.4 million people used it without doctor guidance as per a press release by Heart and Stroke in March 2020.

Aspirin may Not Help African-Americans Prevent Heart Attack
For African Americans, aspirin use did not have a beneficial effect on reducing heart attack risk and could involve a different genetic response to aspirin therapy and poor control of other risk factors, said researchers.

Aspirin and Vascular Events

Although the benefits of aspirin against several vascular agents have been linked for decades, the U.S. review panel has found that the drug may cause internal bleeding in the brain, intestines, and stomach.

Thus, the risks of aspirin outweigh the possible benefits among people especially those over the age of 60 years. Moreover, the Canadian guidelines (published by Heart and Stroke in 2020) recommend no prophylactic therapy of daily aspirin to prevent stroke or heart attack among individuals without a history of cardiovascular conditions.

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” says Task Force member Dr. John Wong, in a press release.

Risk of Internal Bleeding

“I remember when I was a kid, my mom used to tell me an aspirin a day keeps the doctor away, and I think things have changed very much,” says Dr. Ted Wein, a stroke neurologist at McGill University and former chair of the Canadian Stroke Prevention Guidelines, who helped write Canada’s guidelines on aspirin.

Several studies done in 2018 and 2019 revealed that only fewer people (with no history of cardiovascular disease) profited from aspirin intake against heart attacks. On the contrary, increased risk of harmful bleeding was appreciable in the stomach or brain that enforced revision of Canadian guidelines.

Age-Based Disparities

Nevertheless, the study also affirms that younger adults between 40 to 59 years of age and relatively higher risk of cardiovascular diseases should seek expert advice for the start of prophylactic aspirin, as they may claim extra benefits from the drug.

In addition, recommendations for people who are already on aspirin due to prior history of heart attack or stroke do not change. They should in fact stay on aspirin prescription as per experts.

Thus, it is suggested that clinicians think through various factors like differing age groups with risk of bleeding and cardiovascular disease before starting aspirin as a daily regimen for a patient.

“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended. However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician,” says Task Force member Dr.Chien-Wen Tseng.

Facts on Heart Attack and Stroke

Heart attack and stroke are the foremost causes of death and disability respectively.
Stroke and heart attack strike more than 795,000 and 805,000 people annually in the United States respectively.
Heart attacks are silent (the person is not aware of it) in every 1 in 5 individuals.
One in every six deaths from cardiovascular disease was due to stroke in 2018.
Ischemic strokes contribute to about 87% of all strokes.
Stroke-related expenses cost nearly $46 billion in the United States between 2014 and 2015.
Every 40 seconds someone has a stroke and heart attack and every 4 minutes, someone dies of a stroke in the United States.
Lifestyle changes like quitting drinking & smoking, engaging in regular exercise, and healthy diets are beneficial than aspirin in cutting down the risk of heart attack and stroke.

References:

Stroke Facts - (https://www.cdc.gov/stroke/facts.htm)
Heart Disease Facts - (https://www.cdc.gov/heartdisease/facts.htm)

Source-Medindia