Rethinking the 'aspirin a day' mantra for heart attack prevention

One baby aspirin a day keeps a heart attack away. At least that's the understanding a lot of adults have had for some time.

But the U.S. Preventive Services Task Force is revisiting its guidance on using aspirin for heart health. It released a new draft for public comment this month that recommends people with low to moderate risk of heart disease should no longer take low-dose aspirin daily without discussing it with their doctor.

Dr. Retu Saxena is a cardiologoist at the Minneapolis Heart Institute. She joined MPR News guest host Steven John this week to share the latest thinking on heart attack prevention.

Listen to the full conversation with the audio player above.

Let's begin with a reminder of what the current federal guidance is on using low-dose aspirin for heart health?

The U.S. Preventive Task Force has had a recommendation for aspirin for primary prevention. That's for prevention prior to having had a heart attack or stroke for adults. This has been the task force’s recommendation, which is under review. But both the American Heart Association and the American College of Cardiology have not been making that recommendation since about 2019.

What did the task force determine are the risks of using baby aspirin as a preventative measure in the way it is currently recommended?

The recommendation is that in any body, across the board, that aspirin may be beneficial in preventing small heart attacks and small strokes, but not all-cause mortality, meaning it may not [reduce] your risk of dying. And also, it is increasing your risk of having life-threatening bleeding.

Because of this risk of life-threatening bleeding, that's the reason for the draft recommendation that aspirin shouldn't be used for primary prevention across the board.

Does the task force have any other changes, any other recommendations as far as use of baby aspirin goes?

The biggest recommendation from the task force and the draft is that if you're an individual who does not have heart disease, who has not had a stroke, who's not had peripheral arterial disease, that it's really important to have your 10-year risk assessment. This is something cardiologists do and a lot of primary care providers do.

And then ask, if you're between the age of 40 and 60 — according to the draft — ask a doctor whether or not aspirin is right. Based on your risk assessment, those individuals at a higher risk may still benefit from aspirin. For those individuals at a lower to moderate risk, the risk of bleeding from aspirin may outweigh the benefit for stroke and heart attack prevention.

When do we expect to get finalized guidance from the task force?

I think the period where the U.S. Preventive Task Force is soliciting advice is through Nov. 8, and then they would meet subsequently. I don't know that they have a final date out yet.

Beyond whether low dose aspirin is appropriate, what do you want people to think about in terms of preventing heart disease?

Definitely work on eating a good diet, maintaining your physical activity, not being sedentary, not smoking. And then, furthermore, making sure your blood pressure and cholesterol are checked regularly.

And then having your primary care provider or physician calculate your 10-year risk score. If you're in the high-risk category, aspirin may still be applied. Again, if you're in the low to moderate risk category, aspirin is probably no longer recommended for you.

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