#445: Aspirin Therapy - new guidelines discussed by Cooper Clinic cardiologist Nina Radford

In this Cooper Aerobics podcast, Dr. Nina Radford, Cooper Clinic director of cardiovascular medicine, discusses the U.S. Preventive Services Task Force new recommendations regarding aspirin to prevent cardiovascular disease.  The U.S. Preventive Services Task Force looks at all the literature that's come out in individual studies, and tries to compare the studies across age groups and gender, to make recommendations. Historically, the American Heart Association suggested aspirin therapy for individuals with a 6- to 10 percent risk of developing heart disease within the next 10 years. That number comes from the Framingham Risk Score, a clinical calculation tool. The score takes into consideration age, gender, cholesterol, systolic blood pressure and smoking status. For those who don't have a medical risk in taking aspirin (easy bleeding, ulcers, allergies, etc.), a Framingham Risk Score of 6- to 10 percent would indicate aspirin therapy. Then a study came out that specifically looked at the benefits of aspirin in women. We know from a study published a number of years ago that use of a daily aspirin reduced the risk of first heart attack by about 30 percent in men. However, in that study there was an increased risk of hemorrhagic stroke (bleeding within the brain). In the study that came out on women, a reduction in heart attack risk wasn't seen; however, there was a decrease in stroke risk. So, the benefits of aspirin therapy are different in men and women. The new guidelines recommend giving aspirin to men and aspirin to women to prevent stroke. The new recommendations call for low dose 81 mg (baby) aspirin. The task force looked at the risk of taking aspirin compared to the risks (hemorrhagic stroke, irritation to the stomach, and bleeding in the stomach or stomach lining). If you're a man aged 45 to 79, with a Framingham Risk of just 4 percent, you should consider taking aspirin. Women ages 55 to 79 should consider taking low dose aspirin if their stroke risk in the next 10 years is 3 percent in the younger group, 8 percent in the middle aged group, and later than 11 percent in the older age group. Finally, the task force states that for men less than 44 years of age and women less than 54 years of age, it's unlikely that the benefits of aspirin will outweigh the risks. Dr. Radford says there are exceptions to this rule – higher than normal cardiovascular risks, early family history of cardiovascular issues, diabetics, people with high cholesterol, etc. The American Diabetes Association suggests that diabetes 40 years and older take a low dose aspirin daily. Many of us ascribe to the philosophy that "if a little is good, more is better." Is this true with aspirin? Dr. Radford says NO – we increase our risk of stomach bleeding when we take too much aspirin, so we should definitely stick to the 81 mg aspirin and not substitute the adult aspirin of 325 mg. When shopping for aspirin, Dr. Radford encourages us to forgo buying adult aspirin and cutting it up to size (as a cost-saving measure), and to simply buy the basic generic 81 mg aspirin. The baby aspirin that's the "heart aspirin" is simply a marketing campaign that will result in our paying more for the packaging. Reference Information Cooper Clinic Appointments – 866-906-COOP (2667) Task Force Recommends Using Aspirin To Prevent Cardiovascular Disease When the Benefits Outweigh the Harms - http://www.ahrq.gov/news/press/pr2009/aspcvdpr.htm Framingham Risk Score Calculator - http://hp2010.nhlbihin.net/atpiii/calculator.asp Aspirin Prevents Stroke in Women and Heart Attack in Men - http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/2505 An Update on Aspirin in the Primary Prevention of Cardiovascular Disease - http://www.aspirin.org/studies/20030930.pdf Aspirin Foundation of America - http://www.aspirin.org/studies/studies.html