St. Vincent Healthcare's Dr. Erica Bruen discusses new Aspirin guidelines for stroke, heart attack

 Click image below to watch Dr. Erica on KTVQ - Q2 News' Montana this Morning program.


We all know, or perhaps are, that person who has taken aspirin because they believe that it will help prevent them from having a stroke or a heart attack. Why not, right? 

For anyone who hasn’t heard all of the news about Aspirin over the last few months, here’s a recap: 

Doctors previously recommended taking low dose aspirin to patients who were at an increased cardiovascular risk to help prevent a heart attack, stroke or vascular event. 

Keep in mind, we are talking about primary prevention. So this only applies to people who have not already had a heart attack or stent or open heart surgery, stroke, vascular artery occlusion etc.  Aspirin has been shown to be life saving in those patients who are already in that cardiovascular disease category.  

Last Fall 2018 there were 3 huge studies that came out looking closer at whether that advice for using aspirin for prevention was valid.  

ARRIVE trial - 12,000 non diabetic patients with cardiovascular risk factors… aspirin conferred no benefit in preventing heart attack or stroke, but did have an increased risk of major GI bleeding. 

ASCEND trial - 15,000 middle aged or older diabetic patients and found that serious vascular events were very slightly lower in the aspirin group, but the major bleeding rate was also higher in aspirin group. 

ASPREE trial - 19,000 healthy elderly over 65-70 years old comparing aspirin to placebo and found that there was actually higher mortality in patients taking aspirin, primarily related to major hemorrhage, and noted increased death due to cancer in the aspirin group as well.  

Fast forward to current time, the American College of Cardiology and the American Heart Association has released 2019 guidelines addressing these findings.  

ACC/AHA 2019 guidelines:

Low dose aspirin should NOT be given on a routine basis to people over 70 years old without previous heart attack/stroke/vascular disease/stent etc for the purpose of preventing heart attack, or to adults of any age at increased risk of GI bleeding. 

Low dose aspirin can be considered in people age 40-70 with very high risk cardiovascular disease but no increase risk of bleeding.  

Take-Home points:

1. Talk to your doctor before making ANY changes to your aspirin. 

2. If you have already experienced a heart attack, stroke, stents, vascular artery occlusion etc, these guidelines do not apply to you. Aspirin has been proven to be lifesaving in your category. 

3. If you have not had a heart attack, stroke, stents, vascular artery occlusion etc, talk to your doctor about your individual risk of cardiovascular disease balanced with your age and your risk of bleeding to determine whether aspirin is right for you. Chances are, you might be better off without it. 

4. Healthy lifestyle with healthy diet, exercise, blood pressure control, cholesterol control, blood sugar control, smoking cessation all outweigh the benefits of an aspirin for the prevention of heart and vascular disease in the majority of people.  

Dr. Erica Bruen is an internal medicine physician at SCL Health Medical Group - Downtown Internal Medicine. Dr. Bruen completed her residency at the University of Utah Medical Center and was Chief Resident following her graduation from medical school at the University of Utah. She went on to become board-certified in the practice of Internal Medicine. Her focus on helping her patients improve their lives is evident as she encourages and supports them to make healthy choices through strong patient relationships and preventative health management. Warm and welcoming, Dr. Bruen is known for her quick smile, positive attitude
and high level of engagement with patients and staff.

Click here to view her profile page.


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