Jeffrey Berger, MD: Impact of Updated Aspirin Guidelines

While the Apple Heart Study and new guidelines for the treatment of Afib dominated headlines out of the American College of Cardiology (ACC) 2019 Annual Scientific Session in New Orleans earlier this month, new recommendations were also presented regarding the usage of a heart health staple: aspirin. For years, doctors recommended patients take aspirin as a way to prevent heart attacks and stroke.

Despite being a part of a routine for many Americans concerned with heart health, the updated guidelines suggest that taking a daily dose of aspirin may not be right for everyone. Jeffrey Berger, MD, associate professor of medicine and surgery at NYU Langone Health, discusses why he believes these changes are important and what they mean for patients.

MD Mag: What is your opinion on the new aspirin guidelines?

Berger: So, I think the new aspirin guidelines are very important, I think they are timely I think there has been a lot of recent data that has come out that has in my opinion reinforced a lot of the prior data. I think there's a lot of missed communication when it comes to aspirin. I think people see aspirin as a panacea as a miracle drug. That it is something you can just pop into your mouth and it does miracles and I think with these guidelines do is they remind us that there are good things for aspirin and there are not such good things.

For example, aspirin should not be used by everyone for the prevention of a heart attack or stroke, however; those that have established cardiovascular disease — somebody who had a prior heart attack, a prior stent, a prior stroke — aspirin is without a doubt a staple, which means it is very helpful in preventing heart attack, stroke, and death. But the question becomes who should be taking aspirin for the prevention of a first heart attack or stroke and I think one has to remember that there is some data that supports its use but it has to be balanced against its potential risk, right? So, that it's not a free lunch it's not a drug that you take without side effects. There are very serious side effects, serious bleeding both in the GI system as well as in the brain. So really you have to really think about whose benefit outweighs the risk.

So, in my opinion the new guidelines reinforce this benefit versus risk component. It states that there are certain individuals who may benefit from aspirin but you want to make sure that their benefit outweighs the risk and there are certain individuals where the risk may outweigh the benefit. For example, in older individuals above the age of 70 or so there was no compelling benefit in the most recent trial and there was significant risk. So, the guidelines remind us that in populations where the benefit does not outweigh the risk perhaps so you should be holding off.