UH Med Now

This past week, there has been global coverage about the United States Preventive Services Task Force (USPSTF)’s revision to its 2016 recommendation on the use of aspirin to prevent the first heart attack or stroke in adults without a history of such cardiovascular events. Each year in the United States, 1.2 million persons will experience their first heart attack or stroke. Starting low-dose aspirin may have a small benefit for certain people ages 40-59 but has been moved to the ‘not recommended’ column for adults aged 60 years or older who have no history of heart attack or stroke.

The updated guidance recommends that people in their 40s and 50s  make the decision with their primary care clinician by talking about if they are at increased risk of a first heart attack or stroke and balancing the benefits of aspirin against the risk of bleeding. People can be at higher risk for heart attacks and strokes due to diabetes, hypertension, cholesterol, smoking, or family history. The risk for bleeding is increased if they have stomach ulcers, have other health problems, or take certain medications. For people ages 60 and older, risk of bleeding rises with  age and cancels out the benefits of aspirin unless someone has already had a heart attack or stroke.   

Chien-Wen Tseng, MD, MPH, MSEE, the Hawaii Medical Service Association endowed chair in health services and quality research, professor and research director in the department of family medicine and community health at the University of Hawaii John A. Burns School of Medicine (JABSOM), and USPSTF member.

It is important to note that the task force recommendation is not for people already taking aspirin because they had a heart attack or stroke — they should continue to do so unless told otherwise by their clinician.

“The latest evidence is clear. For people ages 40-59, aspirin can have a benefit but it’s small and only for some people. Folks need to talk with their clinician to see whether it’s the right decision for them and not just start aspirin on their own,” said Chien-Wen Tseng, MD, MPH, MSEE, the Hawaii Medical Service Association endowed chair in health services and quality research, professor and research director in the department of family medicine and community health at the University of Hawaii John A. Burns School of Medicine (JABSOM), and USPSTF member. “As we get older, the risks of bleeding increase and the harm cancels the benefit of using aspirin except for people who have already had a heart attack or stroke.”

Tseng has been on the USPSTF for more than five years, for what was originally a four-year unpaid appointment. She was appointed by Sen. Brian Schatz. The task force consists of preventive care experts in family medicine, internal medicine, pediatrics, OB/GYN, nursing, and psychiatry. Tseng says the collaboration has been a once in a lifetime chance to serve and is truly rewarding. 

“We’re independent experts from all over the country, 16 of us, tasked by Congress to work at improving the health of all Americans,” Tseng said. “It has been an incredible honor and experience. I will be sad to step down, but I am also happy to pass the baton to some great people coming on.” 

“I’ve worked with many of these people over time. The Task Force actively looks for diversity so they would welcome future nominations from Hawai’i,” Tseng said. “This has been terrific for me as a family physician. I take care of our community from babies to grandparents. Knowing that the recommendations apply to all of the patients I care for is incredibly meaningful and satisfying. Plus, at JABSOM we are training our next generation of physicians and teaching them about our national guidelines on preventive care. 

Paula Bender, UH Med News Now 

Some of the coverage is below. Note that some sites may have a firewall. 

Aspirin Use to Prevent Cardiovascular Disease (DRS 2021) –  Anderson Cooper 360 – CNN – October 12, 2021

The Lead With Jake Tapper – CNN – October 13, 2021

 Health Experts Change Guidance on Taking Aspirin to Prevent Heart Attacks and Stroke – Katie Couric Media – October 13, 2021

 BBC World News – National Programming – October 12, 2021

https://www.msn.com/en-us/health/medical/most-adults-shouldn-t-take-daily-aspirin-to-prevent-heart-attack-panel-says/ar-AAPqtnR

https://www.bostonglobe.com/2021/10/12/nation/aspirin-use-prevent-first-heart-attack-should-be-curtailed-us-panel-says/?camp=bg:brief:rss:feedly&rss_id=feedly_rss_brief (Firewall)

https://www.nytimes.com/2021/10/12/health/aspirin-heart-attack-stroke.html

https://www.independent.co.uk/news/world/americas/daily-aspirin-heart-attack-stroke-b1937035.html?utm_content=Echobox&utm_medium=Social&utm_campaign=Main&utm_source=Twitter

https://www.washingtonpost.com/lifestyle/2021/10/12/low-dose-aspirin-heart-attack-stroke/

https://www.cnn.com/2021/10/12/health/daily-aspirin-heart-disease-stroke-draft-recommendation-wellness/index.html

https://www.medicinenet.com/script/main/art.asp?articlekey=265739

https://dailyvoice.com/connecticut/darien/lifestyle/panel-shifts-advice-on-aspirin-use-to-prevent-heart-attacks-stroke/817949/

https://www.nbcnews.com/health/heart-health/adults-shouldnt-take-daily-aspirin-prevent-heart-attack-panel-says-rcna2869