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Doctor: New recommendations curtailing low-dose aspirin use follow science, make a ‘tremendous amount of sense’

A bottle of aspirinEmma H. Tobin/Associated Press

The surprising new recommendations from an influential health guidelines group on daily low-dose aspirin regimens reflect the latest science and “make a tremendous amount of sense,” according to a Boston Medical Center expert.

“I think we’re in a really important and interesting time in science, where we’re continuing to let the data guide us to improve the health of populations,” Dr. Katherine Gergen Barnett, vice chair of family medicine at the hospital, said, noting that the public had seen with the COVID-19 pandemic how science evolves rather than staying static.

After years of recommending that middle-aged and older Americans consider taking low-dose aspirin to prevent a first heart attack or stroke, the US Preventive Services Task Force is planning to overhaul its guidelines, based on new studies that show that the risks may greatly reduce or cancel out the benefits.


“Our message . . . is if you don’t have a history of heart attack and stroke, you shouldn’t be starting on aspirin just because you reach a certain age,” said Chien-Wen Tseng, a member of the task force, which is an independent panel composed of experts in disease prevention and evidence-based medicine whose recommendations can influence medical practices and insurance coverage related to preventive measures. The change in recommendations could potentially affect millions of people nationwide, The Washington Post reported.

The task force had also previously seen aspirin as offering benefits in preventing colorectal cancer, but in the new guidance said the latest evidence was unclear, and called for more research.

Dr. John Wong, a primary-care expert at Tufts Medical Center who is a panel member, said, “Aspirin use can cause serious harms, and risk increases with age.” He said that, in addition to newer studies, a reanalysis of older studies prompted changes to the guidance.


Wong acknowledged that the changes might leave some patients frustrated. “It’s a fair question,’’ he said. ‘’What’s really important to know is that evidence changes over time.’’

Barnett said science is “a constantly evolving field that’s based on data” and doctors have to recommend treatments to patients “with the understanding that data is still being collected every day.”

Her message to patients who might be confused about the new guidelines: “I think the most important thing is that people understand that we are absolutely doing everything. We’re using all the right tools in the toolbox to prevent heart disease.”

Barnett said over time it’s become clear there are other effective ways to lower heart disease and stroke risk - and more has been learned about the dangers of bleeding caused by the aspirin regimens.

“The fact is we have a lot of other tools that we can use now, including obviously lifestyle management - stopping smoking and [getting] exercise - but also getting cholesterol down and sugars down, and blood pressure down,” she said.

Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The prevention task force’s guidance does not change that advice. “The benefits still outweigh the risk for people who’ve already had a heart attack or a stroke,” Barnett said.

People who are taking preventive doses now but don’t have a history of heart attack or stroke should consult with their doctors before quitting, the task force also said.


Dr. Robert Wachter, chairman of the department of medicine at the University of California, San Francisco, said in a tweet, “It’s now clear that when used for primary prevention (in [a patient] who hasn’t yet had heart disease or a stroke), the risks of aspirin outweigh benefits – it shouldn’t be used this way.”

Dr. Eric Topol, a cardiologist who is a professor of molecular medicine at Scripps Research in La Jolla, Calif., said in a tweet, “This is a big turnaround. So much for the aspirin prevention of heart attack and stroke story.”

Material from Globe wire services was used in this report.

Martin Finucane can be reached at martin.finucane@globe.com.