A counterorder that is a real backtrack: no more aspirin to prevent the first cardiovascular event in those at risk. The decision of the task force of the American preventive services is lapidary: those between 40 and 59 years old should decide with their doctor whether to start, above 60 it is better not to start at all. So no more routine prescriptions for those at risk of a cardiovascular event, stroke or heart attack, but who have not yet had that event. The American recommendation is based on evidence: the risk of serious side effects goes beyond the benefits of what was hitherto considered a very cheap weapon to prevent cardiovascular disease, which is the number one cause of death.

The same recommendation could also come for the use of low-dose aspirin as a prevention of colorectal cancer, also contained in the American recommendations of 2016: very recent data question whether its use really brings benefits and in any case more and more extensive studies are needed.

The use of the so-called aspirinetta or baby aspirin in the USA – where the 81 mg dosage exists – was so far recommended under the age of 60 for people at high risk of heart disease and for those for whom a first heart attack or stroke could be hypothesized. So let’s talk about primary prevention, which concerns people potentially at risk, but who have not yet had a cardiovascular event.

Aspirin inhibits the formation of blood clots that can block arteries, but according to some studies, regular use increases the risk of bleeding, especially in the digestive tract and brain, which increases with age. Bleeding usually occurs relatively soon after starting regular aspirin use.

“We can no longer claim that anyone who is most at risk for heart disease, even if they have never had a heart attack, should take aspirin,” he said. Chien-Wen Tseng, member of the American National Task Force. “Rather, we need to be able to identify the people who can benefit most from primary prevention with the least risk of harm. We do not recommend that anyone stop treatment without talking to their doctor, let alone if they have already had a stroke or a heart attack”.

The task force includes 16 experts in disease prevention and evidence-based medicine who meet periodically to evaluate new studies and preventive treatments. The new indications, which are not yet definitive, concern at least ten million people at high cardiovascular risk in the United States alone. Two years ago, the American College of Cardiology and the American Heart Association narrowed down their recommendations by suggesting that aspirin should be very selectively prescribed to people between 40 and 70 who have never had a stroke or heart attack. Specifying occasional and not general use for aspirin for primary prevention. The task force has now lowered the age to 60.


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