The American Heart Association no longer recommends daily low-dose aspirin to prevent heart attacks in healthy patients over the age of 70, according to new guidelines published Sunday.

Johns Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the recommendations, said:

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease. It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin.”

Since the 1970s, low-dose aspirin, under 100 milligrams or less, has been recommended by doctors for patients at risk of heart attack, as well as for those that have already experienced a heart attack. Aspirin can prevent blood clots, reduce the risk of heart attack, reduce damage to the heart, and the risk of death during an attack.

But today, doctors have improved their ability to treat the risk factors of heart disease, such as hypertension, diabetes, and high cholesterol. And recent research has suggested that the increased risk of gastrointestinal bleeding likely outweighs the benefits of aspirin – especially for those at high risk for internal bleeding. This risk increases with aging, and with kidney or heart disease, diabetes, a history of ulcers, and high blood pressure. Medications like steroids, nonsteroidal anti-inflammatory drugs, and oral anticoagulants can also increase the risk of bleeding.

Other research has raised questions as to whether aspirin offers any benefits at all for patients with a lower risk of heart disease. The new guidelines promote lifestyle changes and statins as  a preferable treatment, as well as statins for those with high cholesterol.

Aspirin may still be recommended for some high-risk patients that struggle to lower cholesterol or manage blood sugar, in cases where there is no otherwise increased risk for internal bleeding. It can also benefit patients that have already had a heart attack, stroke, open-heart surgery, or that have had stents inserted to open clogged arteries. The new guidelines specifically change recommendations for patients without heart disease, and with risk factors for internal bleeding.

For younger age groups, aspirin is now considered a 2b recommendation, indicating that it’s not an ideal choice, and that there is substantial disagreement among experts.

According to Blumenthal:

“Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding.”

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