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Harvard Health Letter, We Explain What the New Recommendations Are

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Harvard Health Letter, We Explain What the New Recommendations Are Brought to you by VOLUME 45 NUMBER 1 NOVEMBER 2019 INSIDE A major change for daily aspirin therapy Ask the Doctor . 2 ϐ Were the old aspirin studies New recommendations could affect millions of people. wrong? Are you at risk for a ou may remember a time when taking prevent a first heart attack or stroke, and secondary cataract? . 3 Ya daily baby aspirin was almost a rite aspirin was associated with an increased Trend: Nordic walking . 4 of passage for generally healthy older adults. risk for bleeding severe enough to require The idea was that, for people with a low to transfusions or hospitalization. The other The kidney stone diet . 5 ϐ AND: Avoid these foods moderate risk for heart disease, aspirin study showed that in people with diabetes therapy was a simple and cost-effective way but no cardiovascular disease, there was Are you drinking too much to help prevent a heart attack or stroke. benefit, but also risk: a 1% reduction in heart alcohol? . 6 ϐ AND: Alcohol use disorder criteria But taking aspirin increases the risk for attack risk, and a 1% increase in bleeding bleeding in the stomach and brain (see “How risk,” explains Dr. Christopher Cannon, a How aspirin affects us . 7 aspirin affects the body,” page 7). cardiologist at Harvard-affiliated Brigham News briefs . 8 For people who’ve already had a heart and Women’s Hospital. ϐ How many caffeine servings attack or stroke, the trigger migraine headaches? benefits of aspirin Big impact ϐ Have you had an HIV test? ϐ Make fast-food meals healthier clearly outweigh the The guideline changes bleeding risks. How- for aspirin use will FROM HARVARD MEDICAL SCHOOL ever, doctors have spent affect millions of peo- Pain Relief Without Drugs or the past 10 years ques- ple. A Harvard study Surgery: Natural and integrative ways to reduce your suffering and tioning if the same is published online July take control of your life true for everyone else. 22, 2019, by Annals www.health.harvard.edu/nopain Earlier this year, of Internal Medicine the debate came to a suggested that about FIVE THINGS TO DO screeching halt, partic- one-quarter of people THIS MONTH ularly for older people. ages 40 or older with- out cardiovascular Add Nordic poles to your daily New strategy 1walk. Using the poles will help disease—29 million you work more muscles and burn In March, the Ameri- people—are taking more calories. (page 4) can Heart Association aspirin each day. Keep kidney stones from (AHA) and the Amer- Among those peo- recurring. Avoid foods with very © monkeybusinessimages© Getty | Images 2 ican College of ple, 23% (6.6 million) high amounts of oxalate, such as Cardiology (ACC) rec- Daily aspirin may pose more risks than benefits are taking aspirin for people who do not have heart disease. spinach and rhubarb. (page 5) ommended against the without a doctor’s rec- Assess your drinking habits. routine use of low-dose (81-mg) aspirin in ommendation, possibly putting them at an 3Check out the list of alcohol people older than 70 who do not have exist- increased risk for bleeding without sufficient use disorder symptoms. (page 6) ing heart disease and haven’t had a stroke, or benefit. Consider whether you need an in people of any age who have an increased 4HIV test. Forty percent of risk for bleeding (from a peptic ulcer, for What you should do Americans haven’t had the example, with sores on the stomach lining There’s no debate about aspirin use among screening, even though it’s advised that can bleed). people who’ve already had a heart attack for all adults. (page 8) “It’s a big shake-up, based on three large or stroke, people who have peripheral Make your fast-food order studies. Two of the three showed there artery disease, or people who’ve had bypass 5healthier. Lose the fries, soda, was no benefit to taking daily aspirin to continued on p. 7 and sugary sauces. (page 8) ASK THE DOCTOR by ANTHONY L. KOMAROFF, M.D., Editor in Chief Were the old aspirin studies wrong? For 25 years, my doctor has recommended low- Editor in Chief Anthony L. Komaroff, MD Q dose aspirin to reduce my risk of a heart attack. Executive Editor Heidi Godman Recently, he told me that new studies indicate that I Editorial Board can stop. What’s changed? Board members are associated with Harvard Medical School and affiliated institutions. Bone Disease Scott Martin, MD, Donald T. Reilly, MD, PhD Millions of people are asking the same question. Cancer Marc Garnick, MD A I’m afraid some of them think that, when Dermatology Kenneth Arndt, MD, Suzanne Olbricht, MD doctors change their recommendations, it means we Endocrinology Alan Malabanan, MD really don’t know what we’re doing. To the contrary, Exercise/Lifestyle I-Min Lee, MD, ScD, JoAnn E. Manson, MD, DrPH Gastroenterology Jacqueline Lee Wolf, MD the recommendation you got 25 years ago was based Geriatrics Suzanne E. Salamon, MD on sound scientific evidence, and so is the recommendation you received recently. Heart Deepak L. Bhatt, MD, MPH, Peter Zimetbaum, MD What’s changed is that recent studies had different results from the studies in Neurology Gad Marshall, MD the 1970s and 1980s that led your doctor to recommend aspirin. On page 1 of this Nutrition Eric B. Rimm, ScD Psychiatry Ann R. Epstein, MD, Michael Miller, MD, issue of the Harvard Health Letter, we explain what the new recommendations are. Ronald Schouten, MD, JD To explain why the change, here’s some history. Urology William C. DeWolf, MD Starting in the 1940s, doctors noticed that people taking aspirin for any reason Women’s Health Karen Carlson, MD, Martha K. Richardson, MD, Isaac Schiff, MD seemed to have a lower rate of heart attacks. Because of that, two large random- • ized trials were initiated, one in the United States (based at Harvard) and one in Customer Service Britain. Pooling the results of the two studies, which involved over 27,000 people, Call 877-649-9457 (toll-free) showed that aspirin reduced nonfatal heart attacks by one- Email harvardHL@ strategicfulfillment.com Online www.health.harvard.edu/customer-service third. It was front-page news. Letters Harvard Health Letter In the past few years, however, several very large studies P.O. Box 9308 involving even more people have concluded that aspirin treat- Big Sandy, TX 75755-9308 Subscriptions $32 per year (U.S.) ment, at best, achieves a small reduction in heart attacks. And aspirin raises the risk of bleeding. So today, low-dose aspirin Licensing, Bulk Rates, or Corporate Sales Email HHP_licensing@ hms.harvard.edu is recommended for people without known heart disease only Online www.content.health.harvard.edu if they are at high risk for getting heart disease, for reasons Editorial Correspondence described in the article on page 1. © ironstealth | Getty Images Email [email protected] Why did recent studies give a different result? It’s not Letters Harvard Health Letter because the older studies were wrong: they were right for Harvard Health Publishing Harvard Institutes of Medicine, 4th Floor their time. What has happened is that over the past 50 years, 4 Blackfan Circle changes in lifestyle and new treatments (like statins) have been lowering rates of Boston, MA 02115 heart disease. In the United States, heart disease death rates have dropped more Permissions than 40% since 1970. Online www.health.harvard.edu/permissions So, the disease that low-dose aspirin was trying to prevent has become less com- PUBLICATIONS MAIL AGREEMENT NO. 40906010 RETURN UNDELIVERABLE CANADIAN ADDRESSES TO: mon. That makes it harder for aspirin to show a benefit. CIRCULATION DEPT., 1415 JANETTE AVE., WINDSOR, ON N8X 1Z1 But don’t misunderstand: if you do have heart disease (including having stents • in your coronary arteries or having had bypass surgery), if you’ve had a stroke, or Published monthly by Harvard Health Publishing, a division of Harvard Medical School if you have peripheral artery disease, low-dose aspirin reduces your risk of future problems from clogged arteries. In association with Belvoir Media Group, LLC, 535 Connecticut Avenue, My bottom line: If you’re between 40 and 70, have no known heart disease but Norwalk, CT 06854. Robert Englander, Chairman and are at high risk for heart disease, and don’t have special risks for bleeding, talk with CEO; Timothy H. Cole, Executive Vice President, Editorial Director; Philip L. Penny, Chief Operating Officer; your doctor about taking low-dose aspirin. And if you do have heart disease, abso- Greg King, Executive Vice President, Marketing Director; Ron Goldberg, Chief Financial Officer; Tom Canfield, Vice President, lutely take low-dose aspirin unless your doctor has recommended against it. Circulation. The goal of the Harvard Health Letter is to interpret medical Send us a question for Ask the Doctor information for the general reader in a timely and accurate fashion. Its contents are not intended to provide personal medical Visit the Harvard Health Blog online: By mail: Harvard Health Letter advice, which should be obtained directly from a physician. 4th Floor, 4 Blackfan Circle, Boston, MA 02115 www.health.harvard.edu/blog © 2019 Harvard University (ISSN 1052-1577) By email: [email protected] Proceeds support research efforts of Harvard Medical School. (Please write “Ask the doctor” in the subject line.) Because of the volume of correspondence we receive, we can’t answer every question, nor can we provide personal medical advice. 2 | Harvard Health Letter | November 2019 www.health.harvard.edu HEALTHY VISION Are you at risk for a secondary cataract? Even after cataracts are successfully removed, a new problem may bring back the same symptoms.
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