Well, the President may not do so, but I, at soon-to-be age 77, WILL follow your advice, precisely because it is evidence-based. Thank you for keeping us up to speed on this and so many other issues. My very best wishes to you and yours for the New Year.
I had been taking low dose aspirin for several years but when the studies came out my primary care physician told me to stop taking it. In January 2024 I had a heart attack (99% blockage in left anterior descending artery), a stent was put in place and I was put on statins to lower cholesterol and blood thinners for a year as well as back on low dose aspirin. After I was taken off blood thinners I was kept on the low dose aspirin which seems to be recommended based on your reporting(I am 66 years old). Thank you for the easy to understand explanation of the studies, especially in light of the president's recent wacky statements about his aspirin regiment.
(Cardiologist here—I sent you some patients for a DCM study years ago…) What is your position on documented vascular (esp. Coronary) disease that has not yet had an event such as MI or proven angina? E. G, If someone had for instance a CT angiogram for instance, and was found to have asymptomatic 40-50% stenoses; and/or had an abdominal CT for unrelated question, but was seen to have significant but asymptomatic aortic atherosclerosis. What then — they have proven ASCVD but no ‘event’ yet. I am mindful of bleed risks, but other than SAH these can usually be fixed. SCD or significant MI can’t. BTW my admiration for you and your work is immense.
Thank you, Joanne. There's no data for your great question for people age 70+ where the risk of major bleeding events goes up substantially. In younger patients, low dose ASA for the scenarios you described would certainly be reasonable to consider.
Love this and spent the week with my Case classmate Jeff Sunshine and his lovely wife Helen Salz( PhD genetics own lab CWRU).. and specifically reprimanded Jeff on advising aspirin to our friend with a high CAC.. thanks for this timely article:)! Helped my case( no pun intended !.. Lizellen
I would be interested in the data on ASA for SECONDARY prevention of cardio-vascular problems, as well as anything new for those with statin intolerance.
ASA for secondary prevention is Ewell documented as I mentioned in the post. Statin intolerance has many alternatives such as monoclonal PCSK antibodies (Repatha, Praluent) bemzpedoic acid, ezetimibe, Inclisrian, and combinations.
With extreme AFib, a watchman and 81 mG aspirin. Bed ridden, but added digitalis now intend to travel to the Iberian Peninsula for the total eclipse. Idea from a SciAm article (ca 1965) on the medieval use of Foxglove
OMG... America has had RFK Jr corrupt public opinion & casted a dark shadow on the solid scientific data that vaccines are safe & effective.
Now Trump will cause many of his followers to ignore the evidence & encouraged the myth...well if 81 mg ASA is effective taking more will be more effective 😥😥
I had been taking low dose aspirin on the advice of my prior doctor when the advice to not initiate low dose aspirin therapy in most cases came out. I discussed the issue at that time with my current doctor. My doctor said that advice to not initiate a given therapy was not necessarily the same as advice to stop therapy if one was already receiving it. Indeed, the Preventative task force recommendation seems to refer to not initiating low dose aspirin therapy. That seems to leave the question of whether to stop pre-existing therapy open. There appear to be a few studies (observational, I think) suggesting there might be increased risk of certain heart problems if those on low dose aspirin therapy stopped such therapy. I’m 67 now and still taking low dose aspirin daily. Perhaps this is a mistake, but it is not based on being unaware of the changed recommendations. And perhaps the best course of action might change as I get older. Interested on thoughts about stopping existing low dose aspirin therapy. Of course I’m not looking for personal medical advice. I will discuss it again with my doctor at an appointment next month.
Good question. For the next 3 years low dose aspirin can be justified but when you're 70+ the evidence for net harm d/t major bleeding events is clear-cut, no matter whether new initiated or not discontinued, it's the age factor that drives the risk-benefit ratio
This is such a timely, concise, evidence-based discussion of this topic at a time when it has been brought up to a national audience by the WP interview of Trump. It has been a pleasure to see you follow the cutting edge of this field of clinical research since the 1980's. New data continues to contribute to new conclusions that are incorporated into new guidelines. But you are right, it is very hard to change physician's recommendations and often harder to change patient behavior. The Trump case study should be a classic one for medical schools. It seems to be common for patients to use their own logic these days to decide what to do, rather than to respect the immense experience and up-to-date expertise of scientists like you. Judith Kramer, MD MS
Thanks for your comment. I think the issue of discontinuing vs not initiating doesn’t change the consistent finding of an excess of serious bleeding after age 70.
Are there any benefits of taking 81 mg. of aspirin daily for a man in his late 70s who had a few episodes of atrial flutter which needed to be converted twice almost 30 years ago but hasn't had any repeated incidents that he knows of? OTOH, his Kardia always says "sinus rhythm with wide QRS" and he takes a beta blocker and anti-arrhythmic. When the Dr. has been asked about whether a NOAC would be preferable, he said it would make the bleeding risks much higher. What do you think about the benefits vs. the risks of a low-dose aspirin vs. an NOAC in this case, if you think either is even advisable?
NOACS are the only known medication to reduce emboli if atrial flutter and atrial fibrillation. No supportive data for efficacy of low dose aspirin for this indication
Well, the President may not do so, but I, at soon-to-be age 77, WILL follow your advice, precisely because it is evidence-based. Thank you for keeping us up to speed on this and so many other issues. My very best wishes to you and yours for the New Year.
I had been taking low dose aspirin for several years but when the studies came out my primary care physician told me to stop taking it. In January 2024 I had a heart attack (99% blockage in left anterior descending artery), a stent was put in place and I was put on statins to lower cholesterol and blood thinners for a year as well as back on low dose aspirin. After I was taken off blood thinners I was kept on the low dose aspirin which seems to be recommended based on your reporting(I am 66 years old). Thank you for the easy to understand explanation of the studies, especially in light of the president's recent wacky statements about his aspirin regiment.
Thank you, John. No question of benefit for aspirin for you
(Cardiologist here—I sent you some patients for a DCM study years ago…) What is your position on documented vascular (esp. Coronary) disease that has not yet had an event such as MI or proven angina? E. G, If someone had for instance a CT angiogram for instance, and was found to have asymptomatic 40-50% stenoses; and/or had an abdominal CT for unrelated question, but was seen to have significant but asymptomatic aortic atherosclerosis. What then — they have proven ASCVD but no ‘event’ yet. I am mindful of bleed risks, but other than SAH these can usually be fixed. SCD or significant MI can’t. BTW my admiration for you and your work is immense.
Thank you, Joanne. There's no data for your great question for people age 70+ where the risk of major bleeding events goes up substantially. In younger patients, low dose ASA for the scenarios you described would certainly be reasonable to consider.
Love this and spent the week with my Case classmate Jeff Sunshine and his lovely wife Helen Salz( PhD genetics own lab CWRU).. and specifically reprimanded Jeff on advising aspirin to our friend with a high CAC.. thanks for this timely article:)! Helped my case( no pun intended !.. Lizellen
I would be interested in the data on ASA for SECONDARY prevention of cardio-vascular problems, as well as anything new for those with statin intolerance.
ASA for secondary prevention is Ewell documented as I mentioned in the post. Statin intolerance has many alternatives such as monoclonal PCSK antibodies (Repatha, Praluent) bemzpedoic acid, ezetimibe, Inclisrian, and combinations.
With extreme AFib, a watchman and 81 mG aspirin. Bed ridden, but added digitalis now intend to travel to the Iberian Peninsula for the total eclipse. Idea from a SciAm article (ca 1965) on the medieval use of Foxglove
bc ... 88YO.
OMG... America has had RFK Jr corrupt public opinion & casted a dark shadow on the solid scientific data that vaccines are safe & effective.
Now Trump will cause many of his followers to ignore the evidence & encouraged the myth...well if 81 mg ASA is effective taking more will be more effective 😥😥
JJF Phm 🇨🇦
I had been taking low dose aspirin on the advice of my prior doctor when the advice to not initiate low dose aspirin therapy in most cases came out. I discussed the issue at that time with my current doctor. My doctor said that advice to not initiate a given therapy was not necessarily the same as advice to stop therapy if one was already receiving it. Indeed, the Preventative task force recommendation seems to refer to not initiating low dose aspirin therapy. That seems to leave the question of whether to stop pre-existing therapy open. There appear to be a few studies (observational, I think) suggesting there might be increased risk of certain heart problems if those on low dose aspirin therapy stopped such therapy. I’m 67 now and still taking low dose aspirin daily. Perhaps this is a mistake, but it is not based on being unaware of the changed recommendations. And perhaps the best course of action might change as I get older. Interested on thoughts about stopping existing low dose aspirin therapy. Of course I’m not looking for personal medical advice. I will discuss it again with my doctor at an appointment next month.
Good question. For the next 3 years low dose aspirin can be justified but when you're 70+ the evidence for net harm d/t major bleeding events is clear-cut, no matter whether new initiated or not discontinued, it's the age factor that drives the risk-benefit ratio
Thanks Dr. Topol. I appreciate the work you do discussing medical and public health issues in light of science and evidence.
Eric,
This is such a timely, concise, evidence-based discussion of this topic at a time when it has been brought up to a national audience by the WP interview of Trump. It has been a pleasure to see you follow the cutting edge of this field of clinical research since the 1980's. New data continues to contribute to new conclusions that are incorporated into new guidelines. But you are right, it is very hard to change physician's recommendations and often harder to change patient behavior. The Trump case study should be a classic one for medical schools. It seems to be common for patients to use their own logic these days to decide what to do, rather than to respect the immense experience and up-to-date expertise of scientists like you. Judith Kramer, MD MS
Thanks Judith!
A masterful summary thank you! Old myths die hard.
Thanks Tom. No question of that!
Thanks for your comment. I think the issue of discontinuing vs not initiating doesn’t change the consistent finding of an excess of serious bleeding after age 70.
I have a question. Does low dose aspirin have any positive (or negative) effects for people who have had aortic valve replacement? Stents?
Yes, beneficial for patients who have had stenting
Thank you from David and me.
There are rumors that Trump has a stent. If true, his physicians may not be so off-base in recommending low-dose aspirin.
there's no basis for that rumor from all records
Are there any benefits of taking 81 mg. of aspirin daily for a man in his late 70s who had a few episodes of atrial flutter which needed to be converted twice almost 30 years ago but hasn't had any repeated incidents that he knows of? OTOH, his Kardia always says "sinus rhythm with wide QRS" and he takes a beta blocker and anti-arrhythmic. When the Dr. has been asked about whether a NOAC would be preferable, he said it would make the bleeding risks much higher. What do you think about the benefits vs. the risks of a low-dose aspirin vs. an NOAC in this case, if you think either is even advisable?
NOACS are the only known medication to reduce emboli if atrial flutter and atrial fibrillation. No supportive data for efficacy of low dose aspirin for this indication