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FDA gives mixed signals on aspirin use to prevent heart disease

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For years the advice has been for older adults to take a low dose aspirin each day to help lower the risk of heart attack and stroke, but earlier this week, the U.S. Food and Drug Administration did an about face on this logic, well at least part way.

After reviewing what the agency is calling "available data", the new guidance says that there is not enough evidence to support the daily use of aspirin for "primary prevention" of a heart attack or stroke. That is, taking aspirin in an effort to prevent cardiac problems or a stroke before they happen.

According to the agency, not only will taking aspirin each day not do as much as assumed when it comes to prevention, but it can also cause other problems.

"There are serious risks associated with the use of aspirin, including increased risk of bleeding in the stomach and brain, in situations where the benefit of aspirin for primary prevention has not been established," a press release from the FDA stated.

Where taking an aspirin a day does help, the report says, is for patients who have already suffered a heart attack or stroke. Other conditions that warrant the use of aspirin are individuals with existing coronary artery disease such as angina and those who have had coronary bypass surgery or coronary angioplasty.

The use of aspirin in these cases is considered to be "secondary prevention", where the risks of the medication used far outweigh any associated risks. But in these situations, the logic is that patients who are aware of any existing disease such as angina, will be under a doctor's care and it is only when aspirin use is recommended by a doctor that is should be taken. Those who have had further procedures such as bypass or angioplasty will logically be under the care of a cardiologist.

What the report and recommendations finally came down to is the fact that the use of any drug, over the counter or those dispensed through a prescription, should be reviewed and approved by an individual's health care provider.

The FDA offers these steps that should be considered by individuals and their doctors before beginning a regimen of aspirin use.

  • Your medical history and the history of your family members
  • Your use of other medicines, including prescription and over-the-counter
  • Your use of other products, such as dietary supplements, including vitamins and herbals
  • Your allergies or sensitivities, and anything that affects your ability to use the medicine
  • What you have to gain, or the benefits, from the use of the medicine
  • Other options and their risks and benefits
  • What side effects you may experience
  • What dose, and what directions for use are best for you
  • How to know when the medicine is working or not working for this use

Only by consulting with a medical professional will individuals be able to gain the knowledge that is needed to make the proper decisions, the FDA report stated.

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