Millions Taking Daily Aspirin Without Doctor's Approval

Many adults in the U.S. take low dose aspirin daily to reduce their risk of heart disease. However, new research shows taking aspirin without approval from your physician could actually put you in harm’s way.

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Specializes in Clinical Leadership, Staff Development, Education.

The use of low dose aspirin to reduce the risk of repeat heart attacks and strokes is overwhelmingly supported by research. In people who have had a heart attack or stroke, aspirin can be a lifesaving intervention that outweighs the risk for bleeding. However, researchers at Boston’s Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School found in a recent study that approximately 6.6 million U.S. adults are taking aspirin every day to prevent heart disease without first talking with their physician. The study also suggests nearly one-quarter of adults age 40 and older are taking daily aspirin without having a history of cardiovascular disease (primary prevention).

What Did the Research Findings Unveil?

Low dose aspirin has long been an acceptable measure for the prevention of cardiovascular disease and stroke. Although there are known potentially harmful side effects with taking aspirin, the benefits were believed to outweigh the risks. However, three major studies, published in 2018, found the dangers of internal bleeding outweighed the few benefits of aspirin in many people taking it for primary prevention.

The ASCEND Trial

The ASCEND Trial (A Study of Cardiovascular Events in Diabetes) studied 15,480 UK diabetic patients aged 40 years or older. The participants had no history of cardiovascular disease and were assigned 100mg aspirin daily or a placebo as a primary prevention measure for heart disease. Patients were followed for an average of 7.4 years. The trial found:

  • 91 patients would need to be treated to avoid a serious vascular event
  • 112 patients would be treated for a major bleeding event

Overall, the benefit of aspirin in diabetics in the prevention of serious vascular events in the trial did not outweigh the risk of serious bleeding.

The ARRIVE Study

The ARRIVE Study (Aspirin to Reduce Risk of Initial Vascular Events) was a controlled clinical trial on the use of daily aspirin to prevent a first cardiovascular event. Over 12,500 participants, at moderate cardiovascular risk, were assigned 100mg aspirin daily or a placebo. The trial found:

  • 269 patients (4.2%) in the aspirin group experienced a cardiovascular event
  • 281 patients (4.48%) in the placebo group experienced a cardiovascular event

The trial found no difference in cardiovascular or stroke events between nondiabetic patients with cardiovascular risks (but no history of events) who were taking preventative aspirin and those taking placebo.

The ASPREE Trial

The ASPREE Trial (Aspirin in Reducing Events in the Elderly) studied 19,114 people age 70 years or older (age 65 and older for black and Hispanic participants) and no history of cardiovascular disease, dementia or physical disability. There were 9,525 participants assigned to 100mg aspirin per day and 9,589 to a placebo. At 4.7 years, the trial found:

  • Rate of CV disease was 10.7 events per 1000 person-years with aspirin, and 11.3 with placebo
  • Rate of major CV events was 7.8 events per 1000 person-years with aspirin, and 8.8 with placebo

A second report did not show a significant reduction in CV disease with aspirin but did find a significantly higher risk for major hemorrhage.

New Guidelines

The 3 major study findings prompted both the American Heart Association and the American College of Cardiology to revise published guidelines for using aspirin as a primary preventative measure in people who do not have cardiovascular disease.

What are the New Recommendations for Primary Prevention?

  • Low- dose daily aspirin (75 to 100 mg) might be considered for adults age 40 to 70 who are at a higher risk for cardiovascular disease but doesn’t have an increased risk of bleeding.
  • Low dose aspirin should not be prescribed routinely for adults over age 70.
  • Low dose aspirin should not be prescribed for patients of any age who are at increased risk for bleeding.

The guidelines for prescribing aspirin for secondary prevention in patients who have already had one or more heart attacks or strokes has not changed. Even though there is a low risk for bleeding, the benefits of aspirin for secondary prevention outweigh this risk.

Moving Forward

With the overuse of aspirin in U.S. adults without cardiovascular disease, a thorough review of patient home medications is vital. The new guidelines recommend maintaining a healthy weight, not smoking and regular exercise for a healthy heart. The recommendations for daily aspirin in people with a history of heart attacks and strokes have not changed with the new guidelines. As nurses, we should educate patients to always talk to their physician before they stop or start taking aspirin.

Have the new guidelines been implemented in your area of practice?

Resources

The ASCEND Trial: Who Benefits With Aspirin?

ASPREE: No Benefit of Aspirin in Primary Prevention

Millions on Daily Aspirin for CV Prevention, But Probably Shouldn’t Be: U.S. Study

ACC/AHA Guideline of the Primary Prevention of Cardiovascular Disease

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Specializes in Med-Surg/Tele/ER/Urgent Care.

Here are examples of recent poster sent by Bayer to the clinic I work at home along with pics of boxes of baby asa samples they also send. I declined to put posters in my exam rooms as there are enough people self diagnosing and self prescribing unnecessarily.

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Specializes in Clinical Leadership, Staff Development, Education.

Wow, very eye-opening. Thanks for sharing.

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Specializes in Med-Surg/Tele/ER/Urgent Care.

Did you catch the slogan at the bottom, “The Wonder Drug”.

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Specializes in Clinical Leadership, Staff Development, Education.
5 hours ago, PollywogNP said:

Did you catch the slogan at the bottom, “The Wonder Drug”.

I did not... such slick marketing.

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Specializes in Med-Surg/Tele/ER/Urgent Care.
5 hours ago, J.Adderton said:

I did not... such slick marketing.

It’s in Darker ink.

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that's why there are blood tests to determine if the person is vunerable to bleeding or liver/kidney issues before a physician orders any type of medicine....but people who take this without getting check ups and bloodwork...then they shouldn't take it.....but on the other hand...aspirin has been around for centuries....

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think of what was good for you in the past....margarine, smoking was ordered by doctors in the past for nervous tension, Sherry for appetite stimulation, Eggs were BANNED to eat due to cholesterol..now they tell you to eat them, now CBD oil derivative of cannabis(pot)... l(ok..hoping its harmless over time)

plastics were better to use...now look at us now with overload....the list is too long …..they used round up for gardens....ugh..dont get me started to whats good for us and whats not....I feel that if a company makes it . people will buy it with the right lies and untruths associated it with , so who do we believe?

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