May 6, 2019Wall Street Journal (03/18/19) Loftus, Peter

The American College of Cardiology (ACC) and American Heart Association on Sunday said low-dose aspirin should not be given on a routine basis for the purpose of preventing heart attacks and other heart disease in people aged 70 years and older or adults of any age who are at increased risk of bleeding. These guidelines apply to people who have not been previously diagnosed with heart disease. Aspirin became increasingly used for the purpose of preventing a first heart attack after studies in the 1980s and 1990s showed a benefit. Low-dose aspirin may be considered to prevent heart attacks in adults aged 40–70 years who are at higher risk for cardiovascular disease but not at increased risk of bleeding, according to the new guidelines. People at higher risk for heart disease include those with a strong family history of it. The medical organizations made the revised aspirin recommendation as part of a new set of "primary prevention" guidelines for people who have not been diagnosed with heart disease. Doctors presented the guidelines at an ACC conference in New Orleans. The change follows newer studies that flagged a bleeding risk for aspirin, including gastrointestinal bleeding. The new studies "really have shown us the place for aspirin has diminished in terms of primary prevention," said Amit Khera, MD, director of the preventive cardiology program at UT Southwestern Medical Center in Dallas. "Fewer people should be taking aspirin" for this purpose, he added.

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