What might be changing on aspirin guidance: An expert weighs in

By Katia Hetter, CNN

Wait, are we taking a break from aspirin?

While so much of our conversations around health is rightly focused on Covid-19, there are other health developments to discuss with our medical providers.

The US Preventive Services Task Force announced new draft recommendations around aspirin use on October 12. The volunteer panel of disease prevention experts is advising that adults 60 and older to not start taking aspirin to protect their hearts unless they have had previous heart attacks or strokes. The task force also recommends that adults ages 40 to 59 who are at a higher risk for cardiovascular disease, but do not have a history of the disease, should speak with their doctor about whether to take aspirin for heart health.

What’s behind the changes? How does this affect you if you are already on aspirin? Who should consider taking aspirin?

I turned to CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of a new book, “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: A lot of people take aspirin, thinking that it’s harmless. But it seems there could be some risks, too.

Dr. Leana Wen: That’s exactly right. We need to keep in mind that virtually every medication or therapeutic has risks. In the case of aspirin, one possible side effect is an increased risk of bleeding. This is the big reason why the national task force is recommending a change in guidance for older individuals in particular. Older people have a higher risk of falls, and taking aspirin could increase the risk of bleeding in the brain if someone falls and hits their head. There is also an increased risk of gastrointestinal bleeding for people taking aspirin.

CNN: Aren’t there still benefits to taking a daily aspirin?

Wen: Absolutely. Studies have consistently shown that regular aspirin use decreases the risk of heart attacks and strokes.

The question for aspirin and all medications is whether the benefits outweigh the risks. There isn’t a single, one-size-fits-all answer.

There are clearly some individuals who are at high risk for having heart attack and stroke. For these people, specifically people with prior heart attacks or strokes, aspirin use continues to be recommended. There are others who may be at increased risk — for instance, people with hypertension, diabetes and other factors that predispose to cardiovascular disease. On a case-by-case basis, aspirin may still be recommended, depending on someone’s age and other circumstances. Then there are some people on the opposite end of the spectrum, who may have bleeding disorders and probably should not be taking aspirin.

I think what the task force is trying to say is that people shouldn’t assume they need to be on aspirin. There needs to be a careful weighing of risks and benefits.

CNN: What happens if someone is on aspirin now — should they stop?

Wen: No. First, these are proposed, draft recommendations. They are going through a comment period now, and final recommendations are expected in November. As of right now, the recommendations have not officially changed.

Second, the authors of the draft guidelines specifically say that people shouldn’t stop their aspirin if they are already taking them. There could be risks associated with suddenly stopping any medications, including aspirin.

CNN: Should you talk to your doctor about whether you should be on aspirin?

Wen: Yes, of course. It’s always reasonable to have a conversation with your doctor about the medications you’re taking.

Most importantly, make sure your doctor is aware that you’re taking aspirin. I’ve found that because aspirin is an over-the-counter medication, patients often don’t mention they are taking it unless they are specifically asked. Please make sure your doctor knows you’re taking aspirin, and any other nonprescription medication or dietary and herbal supplement.

If your doctor is the one who recommended aspirin to you, you could still have a conversation. Make sure you understand why it is that you’re taking it. Discussing risks and benefits of every medication is always a good idea, as is ongoing reevaluation. Just because something was recommended to you before doesn’t mean that it’s always going to be right, especially as your medical circumstances and clinical guidelines change.

CNN: What if you’re taking aspirin once in a while, for example, when you have a headache?

Wen: There a lot of people who take aspirin or aspirin-containing products for headaches and other occasional ailments. Again, it’s important to let your doctor know that you’re taking it occasionally. There may be better remedies, and aspirin may interfere with other medications you’re taking — for example, if you’re taking other blood thinners or if you have, say, a stomach ulcer, it may not be advisable to take aspirin.

In general, though, the draft recommendations are not directed at those taking aspirin occasionally. They are directed at people who are taking aspirin every day, who think that doing so is preventing heart attacks and strokes. Again, some people may still need to do this, but some may not.

CNN: What if you haven’t yet started on aspirin? Should you hold off before picking up a bottle at the store?

Wen: Talk to your doctor before starting aspirin. I’ve found that many people start taking aspirin because they think it’s the thing to do once they turn a certain age. That’s not the case, and I think that’s the most important takeaway from the guideline change. Aspirin is a medication like other medications. The risks and benefits need to be carefully considered and weighed, together with your medical provider.

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