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New Aspirin Therapy Guidelines

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Dear Dr. Levister: What are the benefits and risks of taking a daily aspirin? V.S.

Dear V.S.: The use of daily aspirin to fight cardiovascular disease has been a long-standing debate between medical professionals.

Because of the increased risk of gastrointestinal bleeding, aspirin, especially in high doses, is not recommended for every patient.

However, U.S. experts have revised aspirin guidelines, stating that lower doses appear to be at least as effective as higher doses and safer at preventing heart attack in men and stroke in women.

The new U.S. Prevent ive Services Task Force guidelines are tailored to match age and gender. Among the recommendations: Men aged 45 to 79 should take aspirin if the chances of preventing a heart attack outweigh the chances of gastrointestinal bleeding (GI). Women aged 55 to 79 should take the drug if the chances of reducing ischemic stroke outweigh the risks of GI bleeding. The recommendations, published in the March issue of the Annals of Internal Medicine, state:

• Men aged 45 to 79 with heart risk factors should take aspirin if the preventive benefits outweigh the risk of bleeding.

• At-risk women aged 55 to 79 should take aspirin if the odds of reducing a first ischemic stroke outweigh the chance of bleeding.

• Men under the age of 45 and women under 55 who have never had a heart attack or stroke should not take aspirin for prevention.

• At this time, it is not clear whether patients aged 80 and older should take aspirin.

Lower doses of daily aspirin (75 milligrams to 81 milligrams) are equally, if not more effective, than higher doses (100 mg or more) in preventing heart attack and stroke in at-risk individuals. High doses may actually do more harm, especially in people taking the clot-dissolving drug clopidogrel (Plavix®).

African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease and stroke. Heart disease and stroke risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes.

Aspirin is the most used drug worldwide to prevent heart attack and stroke, according to recent studies. More than one-third of US adults are believed to take aspirin each day. Always consult your physician before beginning any aspirin therapy.

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