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An aspirin a day?

If you’re taking an aspirin a day to help prevent a heart attack or stroke, that no longer is recommended.

New guidelines by the American College of Cardiology and the American Heart Association state a low-dose aspirin does nothing to prolong the lives of healthy, elderly people. That’s based on a large clinical trial that suggests the pills could instead play a role in major hemorrhages.

The new recommendations say patients who have an increased risk of bleeding, including adults older than 70, should not take a low-dose aspirin every day. Instead, doctors should focus on helping patients optimize lifestyle habits, control blood pressure and reduce cholesterol.

Source: American College of Cardiology and American Heart Association

In the is-it-good-for-you-or-is-it-bad-for-you medical discourse, the use of a baby aspirin daily has largely avoided the give-and-take.

Until now.

Recent research has shown that this traditional preventive care option generally for heart patients may not be as effective as long believed and may be doing more harm than good for certain patient populations.

To try to get a handle on the most current medical thinking surrounding baby aspirin, we checked in with Dr. Andrew Putnam, a cardiologist with the Porter Physician Group at Porter Regional Hospital in Valparaiso.

Q: What are some of the pros and cons for seniors of taking a baby aspirin every day?

A: On the pro side, in patients who have had a heart attack or a stroke, aspirin was shown to reduce the risk of further heart attacks and strokes. However, that benefit is less clear in patients who haven’t had a heart attack or stroke. Nowadays patients are smoking less, are doing a better job of controlling their blood pressure and in many cases are on statin medications. So the additive benefit of aspirin in the context of these improvements is probably much lower than when aspirin was one of the only heart medicines available.

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In terms of the cons, aspirin puts patients at risk of bleeding in the brain and the gastrointestinal tract. In addition to making the platelets in the blood less "sticky" (which is good for patients who have had a heart attack or stroke), it can also cause ulcers in the lining of the stomach and intestines, which can predispose to further bleeding. Balancing the cardiovascular benefit of aspirin and the risk of bleeding continues to be an important topic of conversation among seniors and their doctors.

Q: Is the baby aspirin regimen still recommended for seniors? If not, what changed the thinking in this area?

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A: In patients who have not had a heart attack or stroke, the American College of Cardiology and the American Heart Association recommend not using aspirin in older patients (those older than 70), and those at an increased risk of bleeding. In other words, a typical healthy 75-year-old without known cardiovascular disease should not be taking a baby aspirin. On the other hand, in patients who have not had a heart attack or a stroke but are at a very high risk of a heart attack or a stroke, an aspirin may be appropriate and further consultation with a physician would be advised.

These changes came about because of three recent clinical trials (and other studies) that failed to show the benefit of aspirin in patients without a history of heart attack or stroke.

Q: What other things can seniors focus on to help improve their overall health and well-being?

A: Seniors should focus on remaining physically and socially active, eating a balanced diet and refraining from smoking. Regular visits with their physicians to ensure that other cardiovascular comorbidities — like high blood pressure, high cholesterol and diabetes — are well-controlled may further help reduce the risk of heart attack and stroke.

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