Ask Well: Taking a Daily Aspirin

Adults ages 50 to 69 who are at high risk for heart attack or stroke should take a daily low-dose aspirin to prevent both heart attacks and strokes as well colorectal cancer. That’s the latest advice from the United States Preventive Services Task Force, an influential expert panel that published a final recommendation last month in Annals of Internal Medicine.

It was the first time a major medical organization took this “new approach” of endorsing the broad use of aspirin to prevent cancer, “which makes a great deal of sense,” said Eric Jacobs, a researcher at the American Cancer Society. The recommended dose is a low-dose or “baby” aspirin, typically sold in doses of 81 milligrams.

Low-dose aspirin has long been recommended for some people who have had a heart attack or some forms of stroke, and for certain people at high risk for heart disease. Several of the factors that put one at risk for heart disease — such as obesity and being physically inactive — also play a role in colon cancer.

Some experts think aspirin is too risky for people who have never suffered a heart attack, since aspirin increases the risks of potentially dangerous internal bleeding.

But the task force’s review of the evidence concluded that people in their 50s and 60s who have at least a 10 percent chance of having a heart attack or stroke over the next 10 years could benefit from a daily low-dose aspirin. Those in their 60s are at greater risk for bleeds, which increase with age, so doctors should weigh risks and benefits in individual patients. There is no recommendation for aspirin use for people under 50 or for those 70 and older.

If you’ve ever had a gastrointestinal bleed or ulcer, you probably should not take aspirin. Blood thinners, nonsteroidal anti-inflammatory drugs, omega-3 supplements and uncontrolled high blood pressure also increase your risk of bleeding, and the risk of a bleed is higher for men than for women. Daily aspirin therapy should continue for at least 10 years.

Aspirin may also lower the risk of other types of cancer, including esophageal and stomach cancers, as well as cancers of the breast, prostate and lung, though the level of evidence for these “is too weak to draw strong conclusions” Dr. Jacobs said.

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