Aspirin per day is no longer recommended for most adults. So what should you do?

new US Preventive Services Task Force Guidelines (USPSTF) is again pointing its ax at the well-known health axioms. “Aspirin keeps the doctor away for a day.”

The USPSTF considers the balance between benefits and harms, and for most people, low doses of aspirin (generally 81 mg, commonly known as “baby aspirin”) are the primary prevention of cardiovascular disease (heart attack and stroke). It is recommended not to use it for. Or colorectal cancer.

From a cardiovascular point of view, this recommendation can involve many people in serious medical problems if they do not understand the meaning of “primary prevention”. If the patient has no clinical evidence of cardiovascular disease but is taking aspirin to prevent future heart attacks or strokes, it is called primary prevention. If the patient already has a stroke or heart attack (or tests show that he has asymptomatic cardiovascular disease), the same aspirin is considered “secondary prophylaxis.” Check for and prevent complications.

If you have a cerebrovascular accident and are taking aspirin, do not stop. It’s an important part of making your last heart attack your last heart attack. This is the reason.

Aspirin reduces pain and inflammation, but it is also an anticoagulant. Blood clots are due to the activation of certain coagulation proteins found in the blood or to the aggregation of blood cells called platelets. This is the underlying reaction of most heart attacks and strokes, a reaction that aspirin blocks.

“Cardiovascular disease” refers to a type of scar that usually accumulates in the arteries and is caused by atherosclerosis, diabetes, smoking, high blood pressure, and bad cholesterol. From time to time, this atherosclerotic scar tears open, forming a rough spot that attracts blood clots, which closes blood vessels. Downstream tissues (brain, heart, toes, etc.) die when blood flow passes through little or no obstruction.

The anticoagulant effect of aspirin on platelets can prevent these clots from lowering and is an important secondary prevention for heart attacks and strokes. (If the anti-inflammatory effect of aspirin is strong enough to prevent the development of atherosclerosis first, it is considered primary prophylaxis. Perhaps it does it slightly in all patients, but it does. If so, only the benefits outweigh the risks of medium to high risk 50-59 years.)

In addition, aspirin is doubly important if you are the owner of a stent. A wire mesh tube placed during angioplasty causes an artery blocked by atherosclerosis to bulge and open. The stent prevents the arteries from collapsing, but the stent itself can attract blood clots. So once you get it, you need to take aspirin every day until you die. You should also take more powerful antiplatelet drugs (Plavix, Brillinta) for about a year.

The “risk” in the aspirin risk and benefit equation is primarily due to bleeding and usually occurs in the gastrointestinal tract (such as gastric ulcer). (Drugs like aspirin and over-the-counter painkillers like ibuprofen and naproxen interfere with the ability to produce a coating that protects the stomach from the acidic contents of the stomach.) This gastrointestinal bleeding is usually fatal. It’s more annoying, but it may work. A gastroenterologist armed with an obstructively long fiber tube gives you the opportunity to look up and down. Less common, but much more serious is bleeding into the brain. Ironically, this can cause a stroke that you were trying to avoid in the first place.

The USPSTF makes one exception to the rules, which can be annoying. They recommended aspirin as the primary prophylaxis for adults aged 50-59 years with a 10-year risk of cardiovascular disease of 10% or more (moderate to high). This is the possibility of experiencing a heart attack or stroke in the next 10 years.You can find out by using any number of what your 10 year CV risk is Online calculator.. Your “score” is your stress level by how aggressively you and your doctor want to treat your CVD risk factors, or by joining the current nearly national workforce in early retirement. Can help you decide how quickly and permanently you want to reduce.

In addition to a 10-year CVD risk of 10% or more, qualifiers should have a low risk of bleeding, take low doses of aspirin daily for “at least” 10 years, and have a life expectancy of 10 years. that’s all. (There are some life expectancy data for cancer patients, but otherwise this would be better answered by actuaries than doctors).

It’s a bit unusual to combine cardiovascular disease with colorectal health, but the USPSTF has done it (it is said to “simulate how doctors and patients do about prevention”). There are observational data showing that the use of aspirin reduces the risk of colorectal cancer, but more intensive randomized clinical trials are needed to show its effect. This article from the National Cancer Center I will take you further to the discussion.

what to do? If you are already taking aspirin because you have had a heart attack or stroke (or tests have found asymptomatic cardiovascular disease), leave it alone. This is an important part of avoiding future events. If you’re taking one “just in case”, you might reconsider. If you are 50-59 years old and currently have no CV disease, but have a moderate to high risk of getting it, take two aspirins and send me a text message in the morning. Include a colonoscopy report.