Health experts in the United Arab Emirates have said elderly residents should seek medical advice before using aspirin to lower the risk of heart attacks and strokes, saying in cases the risks of bleeding can outweigh the benefits.
The comments follow a landmark review led by a team of doctors in the US who have said a historical widespread approach of taking aspirin - a blood thinner that can help deal with heart attacks and strokes by preventing the formation of clots in the blood vessels leading to the heart or brain – could be dangerous in some age groups.
It led to a US government expert panel on Tuesday saying it no longer recommends a daily dose of aspirin to reduce the risk of heart attack and stroke in people aged 60 and over.
“Our message is that if you don’t have a history of heart attack and stroke, you don’t need to start taking aspirin just because you’re a specific age,” said Dr. Chien-Wen Tseng from the task force, which includes 16 evidence-based disease prevention and medicine experts.
These experts periodically evaluate screening tests and preventative treatments. They’re appointed by the director of the federal Agency for Healthcare Research and Quality, and their recommendations often change US health guidelines.
Adults between 40 – 59 should consult doctor
People aged 40-59 who are at a higher risk of developing cardiovascular disease but have no history of it, should consult with their doctor and make an individual decision on whether to start taking the medicine.
Dr. Amal Louid, a consultant interventional cardiologist at Canadian Specialist Hospital in Dubai, agreed that there should be a U-turn on some of the guidelines.
“Aspirin has been used for many years in patients who have heart disease and also in preventing heart disease,” he told Al Arabiya English.
When used in otherwise healthy people to prevent heart disease it is called primary prevention and when used with people with heart disease it is called secondary prevention, the doctor said, stressing it was important to differentiate between the two.
“This whole data is about primary prevention which is using aspirin as a routine preventative measure in people between the ages of 40 to 60 or 60 and above.”
“While there is some data showing there is some benefit (of using aspirin) - especially in people who are at high risk - the risk is usually calculated using a risk score using a person’s age and the prevalence of other conditions such as diabetes, smoking, high cholesterol and high blood pressure, etc.”
If the risk of developing heart disease was high then it was advised to give aspirin, said the doctor.
However, the reason for the latest systematic review affects the primary prevention group, said the doctor, with the study showing that that the risks could outweigh the benefits of taking aspirin in people with no history of heart-disease or at low risk of developing complications in the future.
Simply put, the doctor said people should not be taking aspirin simply because they reach a certain age group – and should also seek medical advice before self-treating with any medication.
“The review has led to the conclusion now, that generally over the age of 60 the bleeding risk is much higher than the benefit of having heart attack so now it has been advised not to use aspirin as routine in people over the age of 60 to prevent heart attacks.”
Patients in this age group who have experienced heart disease – such as strokes, clots or blockages – in the past, should still continue with aspirin as their risk of developing further heart disease in the future is higher.
For those in the 40 to 60-year-old age group, again, those patients who have never had heart disease or deemed low risk should avoid taking aspirin preventative measure.
“Even in this group the bleeding risk is high,” Louid said.
Overall heart disease risk calculation
Patients should visit doctors to be given a calculated risk score on their chance of developing heart disease, he said.
“The physician has to make a decision on an individual basis, calculating the overall risk score of a patient having a heart attack in the next ten years,” Louid said.
If the risk-score is 15 percent or more then aspirin is recommended, for those lower than this risk, aspirin should be avoided, he added.
“This is only for use in primary prevention - so people not known to have problems. However, in secondary prevention – so people of any age group – i.e., people who have already had a heart attack or blood clot or blockages etc. should take aspirin because in those cases the benefits outweigh the risks of bleeding.”
According to the World Health Organization, Cardiovascular diseases (CVDs) are the leading cause of death globally. An estimated 17.9 million people died from CVDs in 2019, representing 32 percent of all global deaths. Of these deaths, 85 percent were due to heart attack and stroke.
Most cardiovascular diseases can be prevented by addressing behavioral risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol.
Last month, Al Arabiya English reported how more than half of residents in the United Arab Emirates have been affected by heart disease during their lifetime, according to a new study of thousands of people across the country.
The survey of more than a thousand UAE residents revealed that 55 percent of respondents had been directly affected by heart disease, either through being diagnosed themselves (12 percent), having a close friend or family member diagnosed with heart disease (53 percent), or both.
The survey was commissioned by Cleveland Clinic Abu Dhabi ahead of World Heart Day on September 29.