The U.S. Preventive Services Task Force this week revised low-dose aspirin recommendations. It’s not recommended that people over 60 begin a low-dose aspirin regimen because of the risk of internal bleeding.
WEKU spoke to Dr. Vendant Gupta about the new recommendation.
WEKU: With the new recommendation for low-dose aspirin, why has this changed? And if people are on this regimen, do they need to go ahead and contact their doctor?
Gupta: Yeah. So I would actually say that the evidence for just the routine use of low-dose aspirin, meaning that everybody regardless of an individualized discussion, being on aspirin probably has been a question in the healthcare community for a while. There have been three new studies here recently, which is probably what brought this back up to the forefront. So what I will tell most people and most of my patients, this is still a very individualized discussion, something that they and their doctors should discuss. But what we do know is this previous recommendation of you know, everybody should be on an aspirin, regardless of whether they've had a heart attack or stroke, or without a clear idea of what their individual risk of a heart attack or stroke is, is probably not the best approach across the board. But I think on an individual level, there may be some individual patients that still benefit from being on a low dose aspirin. And it's just a balance between the risk of a heart attack and stroke versus the risk of bleeding, which we know aspirin can put you at higher risk for.
WEKU: This new recommendation says that adults over 60 years old, they recommend against initiating a low dose aspirin use where the primary prevention of cardiovascular disease. If you're over 60, it's not going to be recommended anymore, that you go on a low-dose aspirin?
Gupta: For most of my patients, it will be a risk benefit discussion, we know patients over the age of 60 are at a higher risk of bleeding. And so for those that we know have had issues with bleeding before, or that the risk of a heart attack or stroke is low enough, we may not recommend starting a low dose aspirin. Yet, there will be some patients who either, because of a family history or because of other risk factors that they may have things like diabetes or high blood pressure, we may have a, you know, shared decision making conversation that, hey, this is the risk of starting a low dose aspirin. And, this is the benefit which for you may be still worth it. So there will be some patients even above the age of 60, that still may benefit from it. But I do think what this has done, it's shifted the priority to us as healthcare providers to help patients make that decision with them.
WEKU: There's a public comment period right now, but once the US Preventive Services Task Force comes out with the final recommendation, will that be the permanent recommendation?
Gupta: No, usually not, usually,this is sort of the period of time where patients healthcare providers have the opportunity to weigh in. If there's a concern about the quality of the data that's there. I will say this has been a fairly consistent trend. These three newer studies didn't show us anything we didn't already know. It just sort of added to that evidence so that we know that the benefit is really low. in patients who have not had a history of heart attack or stroke. When we look at everybody about the age of 60. The risk of bleeding is a little bit higher in that age group. That risk is also fairly low. And so for everybody above the age of 60, probably not fair to recommend everybody be on a baby aspirin for a low dose aspirin.
Q: It's really important that lots of people know that this is the case right? So in case people have started their own regimen without talking to their doctor. They [need] to know that this has come out. What do you think is the best way to make sure everybody knows about this?
Gupta: Yeah, so I think this is important. And I think this is an important aspect of any of these recommendations that come out. I think just communicating it with the healthcare field is not enough. I do think that, as providers, it's important that we revisit these conversations when we're having our patients in the clinic or having communications with our patients. But I do think that, in general, there has to be some education broadly. And so I think opportunities like this are a good opportunity to be able to communicate that, not to scare people or alarm people that if they're on a baby aspirin that, you know, something untoward is going to happen, and they need to stop it right away, or that nobody should ever be on an aspirin again, but really having a honest conversation with their health care provider to help them understand their individual risk and whether it's beneficial for them on an individual level.
Q: And Dr. Gupta, is there anything else you'd like to say or add about this recommendation?
Gupta: Again, like with most things, when we study these topics in large patient populations, we may find things like this and that is okay. This is really an opportunity for us to individualize our care for our patients. And so understanding their risk on an individual level is as important as anything else. So understanding their family history and their risk factors helps their healthcare providers with giving them the proper recommendation. Not to say that the US Preventive Services Task Force recommendation is not important. But I do think what it does is it shifts it to a really individual decision.
