Risk vs. benefit of low-dose aspirin regimen

SOURCE: Seacoastonline.com

PORTSMOUTH -- Older adults looking to reduce their risk of a heart attack or stroke should no longer automatically begin a regimen of low-dose aspirin.

While an aspirin regimen has been used since the late ’80s and early ’90s, the latest recommendation from the American College of Cardiology and the American Heart Association no longer prescribe aspirin routinely, but first weigh the risk against the benefit.

Dr. Peter Dourdoufis, Chief of Cardiology at Portsmouth Regional Hospital, said people whose doctors have recommended an aspirin regimen should not simply stop taking it. Instead, he said, they should have a discussion with their primary care doctor to see if they should continue or not.

“We are so good now at controlling blood pressure and cholesterol that this practice is being reconsidered,” said Dourdoufis. “We need to weigh the risk of bleeding complications from the aspirin against the potential to prevent a heart attack or stroke.”

Maureen Brady, a clinical ambulatory care pharmacist for Wentworth Health Partners Internal Medicine, said the new recommendation changes what has been common practice for decades.

“Still, for people at a higher risk, the aspirin regimen does have benefits that might outweigh the risk,” said Brady. “It has to be considered on an individual basis.”

Dourdoufis said people age 40 to 70 who are using the aspirin regimen, but have never had a cardiac event are primary prevention patients, while those who use it and have had a heart attack, or a stroke are considered secondary level.

“Aspirin is a medicine and has potential negative side effects, bleeding being the most serious,” said Dourdoufis. “A study of 250 patients shows the regimen might prevent one heart attack, but one patient might get a bleed, intercranial or other. So, the benefit is really not worth having everyone doing this.”

Dourdoufis said people in the primary category, having never had an incident, should carefully consider their risk factors, including family history. He said they should discuss their history with their doctor to determine whether there is a potential benefit to having them use the aspirin or not.

“I have been receiving calls from patients, wondering if they should stop or telling us they have already stopped taking aspirin on hearing this news,” said Dourdoufis. “These people, being patients of ours, have already had a heart attack or a stroke. Secondary patients like this should continue the aspirin regimen because they are at a higher risk of having a second event.”

The American Heart Association has a cohort risk calculator tool used to determine risk. Dourdoufis said if the risk is 20 percent or more, aspirin regimen will still be considered.

“For those in the 10 to 20 percent risk factor, the question is more of a gray area,” said Dourdoufis. “We have to think - is it worthwhile? People who are considered low-risk should not be on an aspirin regimen at all.”

Brady said for people who are low-risk, the risk-benefit ratio is a wash. So, it is likely not worth it.

“You want to help prevent a heart attack, but you risk a bleeding event,” said Brady. “For some people, it will still be appropriate. We no longer recommend an aspirin regimen for anyone over the age of 70. For older people or people who have a risk of bleed, the risk definitely outweighs the potential benefit.”

The bottom line, said Brady, is that anyone aged 40 to 70 should have the conversation with their doctor if they are concerned.

“In most cases, the doctor will probably not recommend an aspirin regimen,” said Brady. “If they are already doing this, their doctor may tell them it is no longer necessary.”