By Steve Bond, BScPhm, RPh, CDE
Recently, the concept of whether or not acetylsalicylic acid (ASA, Aspirin) should be taken regularly and the benefits versus risks has reemerged in the news. This is because on October 12th, the U.S. Preventive Services Task Force (USPSTF) released draft recommendations on aspirin therapy for the primary prevention of heart disease and stroke in adults. This is not a new story. It is one that has resurfaced and USPSTF recommendations simply align with the recommendations of American College of Cardiology/American Heart Association and Heart and Stroke Foundation of Canada in collaboration with the Canadian Stroke Consortium.
These guidelines have been available for almost two years and are based on three landmark trials:
- ASCEND (A Study of Cardiovascular Events in Diabetes)
- ASPREE (Aspirin in Reducing Events in the Elderly)
- ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events)
Collectively, these trials demonstrated that taking an Aspirin a day, without a physician recommendation, poses a greater risk than a benefit. In particular, simply reaching a certain age should not be reason to start Aspirin. If you’ve had a heart attack or stroke and your doctor recommends it, then that would be a good reason.
So why the recent change from USPSTF and from other agencies a few years ago? Well, the studies are compelling; they showed that the benefits of Aspirin do not outweigh the risks in people with no history of heart disease or stroke. The other consideration is that we have taken huge steps in managing heart disease over the past three decades. This means that when the risk of heart disease is high, we expect that ASA will provide benefit. However, as the risk diminishes, ASA only helps those with the greatest chance of heart disease.
To clarify this point, life jackets help save lives. This is a commonly accepted truth. But, if the risk of drowning is low, such as when you are sitting at your desk, then the benefit of a personal flotation device is no longer relevant. If however, only people on boats wore life jackets, then we would maximize their value.
So if your doctor recommends Aspirin, continue taking it. If you are thinking it might be good for you, ask your doctor first. What is good for one person may not be good for another. Take care of yourselves and each other.