THE PROS AND CONS OF DAILY ASPIRIN THERAPY

Daily aspirin is most beneficial in your 50s, panel says By Cari Nierenberg Published April 12, 2016. 

People in their 50s or 60s may benefit from taking aspirin daily, but those who start during their 50s get the most benefit from its use in preventing a heart attack, stroke and colon cancer, according to new recommendations from a government-appointed panel of independent experts. Daily aspirin is also beneficial for men and women who start taking it in their 60s, but its overall benefits are smaller than those for people who start taking it in their 50s, according to the new advice from the U.S. Preventive Services Task Force (USPSTF). Taking one daily low-dose (81 milligrams) aspirin tablet may be an inexpensive and effective way to help reduce the rates of heart disease, cancer and stroke, which are major causes of deaths for adults in the U.S., the USPSTF said. But when people are in their 60s, the balance between the potential benefits and possible harms of using aspirin changes, said Dr. Kirsten Bibbins-Domingo, chairwoman of the USPSTF and a professor of medicine at the University of California, San Francisco. As people get older, they face an increased risk that aspirin use will result in bleeding in the gut, she said. Moreover, people may not live long enough to realize the benefits of aspirin as a preventive for colorectal cancer, Bibbins-Domingo added. The advice issued April 11 marks the first time that the task force has made a recommendation for using aspirin to prevent both cardiovascular disease and colorectal cancer. (Previously, the task force released separate recommendations for aspirin use in curbing colon cancer risk in 2007, and one for staving off cardiovascular disease in 2009.) The new recommendations apply to adults ages 50 to 69 who have a 10 percent or greater risk of developing cardiovascular disease in the next 10 years and who are not at increased risk for bleeding from aspirin therapy, according to the USPSTF, a medical advisory panel that makes recommendations on the effectiveness of preventive health services for Americans.  5 Interesting Facts About Aspirin ] When determining a person's cardiovascular risk, doctors consider factors such as age, sex, blood pressure, cholesterol and lipid levels, as well as a history of diabetes and smoking. Heart and cancer protection To form the recommendations, members of the task force reviewed the latest research on the role of aspirin therapy in preventing heart disease, stroke and colorectal cancer, and they developed computer models to estimate aspirin therapy's benefits and harms in adults ages 40 and older. The data showed that the health benefit is definitely larger the earlier a person starts taking aspirin, Bibbins-Domingo said.  But this does not mean that adults in their 40s should begin taking daily low-dose aspirin to prevent heart disease and cancer. The USPSTF did not find enough scientific evidence to make a decision about the pros and cons of initiating aspirin use in people younger than 50, or in those ages 70 and older. About 40 percent of U.S. adults older than 50 take aspirin to prevent heart disease and stroke, according to a recent review study .  Studies have found that people need to take regular low-dose aspirin use for at least five to 10 years before they see the benefits of protection from colorectal cancer, Bibbins-Domingo said. The preventive benefits for cardiovascular disease are more immediate, and seem to begin within the first five years of daily aspirin use, she said. Aspirin may work to protect against heart attack and stroke by helping to prevent blood from clotting in the arteries that lead to the heart and brain that may be narrowed by atherosclerotic plaques. Aspirin's role in preventing colon cancer is not well understood, but it may help reduce inflammation that can promote cancer development, the researchers said. For adults who begin low-dose aspirin use in their 50s, the benefits outweigh the increased risk of gastrointestinal (GI) bleeding by a moderate amount, Bibbins-Domingo said. The benefits of daily aspirin use are smaller in people in their 60s because of a higher risk of GI bleeding and hemorrhagic stroke (which occurs when a blood vessel bursts) in this age group, she said. Before starting to take aspirin daily for preventive reasons, people should have a conversation with their doctor to understand the benefits and risks, and this discussion should recur as people age if they remain on low-dose aspirin over time, Bibbins-Domingo said.