The latest health guidance on taking aspirin as heart attack, stroke preventative

Adults 60 or older should not necessarily take a daily aspirin to prevent a first heart attack or stroke, according to a draft recommendation from the U.S. Preventive Services Task Force. The government-backed panel of independent experts is revising several key guidelines and warning that, for some, aspirin's risks may outweigh the benefits. Judy Woodruff talks to Dr. John Wong about the issue.

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  • Judy Woodruff:

    Adults who are 60 years old or older should not necessarily take a daily aspirin to prevent a first heart attack or stroke.

    That is according to a draft recommendation from the U.S. Preventive Services Task Force, a government-backed panel of independent experts. The task force is revising several key guidelines and warning that, for some people, the risks of aspirin outweigh the benefits.

    I'm joined by Dr. John Wong. He is a member of the task force. He is a primary care expert at Tufts Medical Center in Boston.

    Dr. Wong, thank you for being with us.

    And I want to be as clear as possible about, exactly what is this advice for people who are over 60 and who are not yet taking a daily aspirin?

  • Dr. John Wong, Tufts Medical Center:

    First, let me thank you for your interest, Judy.

    This is a very important recommendation. It has to do with preventing stroke and heart attacks, which account for one in three deaths. So it is a very important recommendation for helping all people in this country stay healthy and live longer and better.

    We, based on new information, have made substantial changes. But, in particular, we used to recommend that people in there 60s speak with their clinician about whether starting aspirin would be right for them. But we now find that the bleeding risk cancels out the benefit.

    Bleeding risk increases as people get older. And thus we have changed our draft recommendation to recommend not starting aspirin in their 60s.

  • Judy Woodruff:

    So, this is based on additional research.

    And are you saying people should not talk with their doctor about this? What exactly is your advice to individuals?

  • Dr. John Wong:

    Any time anyone is concerned about their stroke or heart attack risk, we would encourage them to speak with their clinician, who can then help them assess what their individual risk is for a stroke or heart attack, as well as whether or not aspirin is appropriate for them.

    But, when we look at the evidence, the risk for people in their 60s and older, cancels out or balances out the benefits, so that we would not end up recommending it. For people who are younger, we used to recommend starting aspiring. But we now recommend that they speak with their clinician about aspirin, because the balance of benefits and harms is now closer.

    And for people in their 40s, we, in 2016, weren't sure if they should or should not take aspirin. We now find that some people may benefit from aspirin. So they should have a discussion with their clinician to see if aspirin is right for them.

  • Judy Woodruff:

    But I hear you saying, bottom line, if there's any question in people's minds, they should be talking to their clinician.

    And, again, this does not apply to people, as I understand it, who are already on a daily dose of aspirin; is that correct?

  • Dr. John Wong:

    That is certainly correct.

    If you are already taking aspirin, this recommendation really focuses on people who are thinking about starting aspirin. If you're already taking aspirin, you should speak with your clinician about whether or not that is appropriate for you.

  • Judy Woodruff:

    To continue doing it.

    And another question. You — and you pointed to this. This is a change in guidance. And it's still a draft recommendation. But it sounds like you're saying it's enough of a serious point in the research that people should go ahead and take this advice.

  • Dr. John Wong:

    For anyone who's concerned about their heart disease risk or their stroke risk, we would encourage them, as you mentioned, to speak with their clinician, because it's a balance of, what is your risk for having a stroke or heart attack and, as we have discovered with new information, what is your risk for a bleeding complication from aspirin, and thinking about that balance of benefit vs. harm, and then coming to the right decision for yourself.

    For people who are 60 and older, when we look at the evidence, we find that the risk of bleeding, which increases with age and exceeds the benefit for those who are 70 and older, and basically cancels out the benefits for people in their 60s.

  • Judy Woodruff:

    Dr. John Wong, who is a member of this task force making this draft recommendation, thank you very much.

  • Dr. John Wong:

    Thank you, Judy.

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