An aspirin a day should not keep doctor away

An aspirin a day may keep heart attacks and cancer away, according to new recommendations by a medical panel. But that doesn’t mean everyone should run to the drugstore without talking to his or her doctor first.

The U.S. Preventive Services Task Force, an independent panel of medical experts from around the nation, said Monday that taking aspirin can help 50- to 59-year-olds who are at increased risk of cardiovascular disease prevent heart attacks and strokes.

The panel also said that taking aspirin for at least five to 10 years could help prevent colorectal cancer. Individuals 60 to 69 may also benefit from aspirin, but the benefit is smaller than in people 50 to 59.

Because heart attacks are caused by blood clots in the arteries, aspirin can help prevent heart attacks and strokes that are caused by these clots.

It is the first time the task force has included both the evidence on preventing cardiovascular disease and colorectal cancer in developing recommendations on aspirin use in patients at high risk of cardiovascular disease.

Stanford Professor of Medicine Douglas K. Owens, a member of the task force, cautioned the new recommendations come with a caveat: a daily dose of aspirin can cause stomach and brain bleeds. People with stomach and liver problems, bleeding disorders or who are taking blood thinners, are at greater risk of experiencing the side effects of aspirin.

And, he emphasized, the new recommendations are for older adults and those with substantially elevated risk of cardiovascular disease.

“It is nuanced,” said Owens, director of the Center for Health Policy/Center for Primary Care and Outcomes Research. “Our recommendation applies to people who are at increased risk of heart disease and who do not have increased risk of bleeding complications.

He added that those risk assessments by physicians are extremely important.

The task force, an independent panel of experts in prevention and primary care appointed by the Department of Health and Human Services, said a “pragmatic approach” consistent with the evidence is to prescribe 81mg per day, or one baby aspirin, which is the most commonly prescribed dose.

“Each person has only one decision to make — whether or not to take aspirin for prevention,” said Owens. “To help individuals and their clinicians make this decision, the task force integrated the evidence about the use of aspirin to prevent cardiovascular disease and colorectal cancer into one recommendation on the use of aspirin.”

But the task for also concluded that it doesn’t have enough to current evidence to assess the balance of benefits and harms of aspirin use in adults younger than age 50 and those older than 70.

The draft guidelines, which are open for public comment on the task force website, have provoked criticism by some cardiologists and physicians who are concerned that healthy Americans who start taking aspirin on a daily basis could expose themselves to the drug’s negative side effects, such as stomach bleeding and hemorrhagic strokes.

And the Food and Drug Administration wrote last year that it had reviewed studies on the use of aspirin for primary prevention of a heart attack “and did not find sufficient support for the use of aspirin.” The agency did say, however, it was awaiting results of additional clinical trials.

Owens said that while the FDA looked at aspirin to prevent an initial heart attack or stroke, “the task force looked at evidence for the broader benefits of aspirin to reduce heart attacks, strokes and colorectal cancer.”

In addition, Owens said, the evidence review for the task force included a wide variety of research, including meta-analyses, which may not have been included in the FDA review. The task force commissioned three systematic reviews, he said, as well as a sophisticated modeling study to help integrate the evidence about cardiovascular disease and cancer.

So what’s the bottom line? Consult your physician.

Because, as task force vice chair Dr. Kirsten Bibbins-Domingo said, “Taking aspirin is easy, but deciding whether or not to take aspirin for prevention is complex.”

Listen to Owens' interview on NPR's Morning Edition.