Recent guidelines have restricted aspirin use in the primary prevention of heart disease to patients under 70, and more recent guidance to patients under 60.
Yet, the risks of heart attacks and strokes increase markedly with age.
There has been considerable confusion from recently reported results of four large-scale studies, two of which showed significant benefits of aspirin, but the other two, based possibly on poor adherence and follow-up, did not.
As a result, health care providers are understandably confused about whether or not to prescribe aspirin for primary prevention of heart attacks or strokes, and if so, to whom.
In a new study from Florida Atlantic University, researchers provide guidance to primary care providers and their patients.
The authors urge that to do the most good for the most patients in primary prevention of heart attacks and strokes, health care providers should make individual clinical judgments about prescribing aspirin on a case-by-case basis and based on benefit-to-risk, not age.
They conducted an updated meta-analysis and found aspirin produced a 13% reduction in heart disease with similar benefits at older ages in each of the individual trials.
They suggest that any judgments about prescribing long-term aspirin therapy for apparently healthy individuals should be based on individual clinical judgments between the health care provider and each of his or her patients that weigh the absolute benefit on clotting against the absolute risk of bleeding.
For long-term use of aspirin or any over-the-counter drug, patients should consult their primary care provider.
The authors say that primary care providers have the most insight and knowledge to make appropriate recommendations in collaboration with their patients.
Primary care providers also should be aware that all patients suffering from an acute heart attack should receive 325 milligrams of regular aspirin promptly, and daily thereafter, to reduce their death rate as well as subsequent risks of heart attacks and strokes
In addition, among long-term survivors of prior heart attacks or occlusive strokes, aspirin should be prescribed long-term unless there is a specific contraindication.
In primary prevention, however, the balance of absolute benefits, which are lower than in secondary prevention patients, and risks of aspirin, which are the same as in secondary prevention, should be an individual clinical judgment.
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The study is published in the Family Medicine and Community Health, British Medical Journal. One author of the study is Sarah K. Wood, M.D.
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