DoctorOz: Rethink Your Daily Aspirin: Is it Right for You?

Earlier this week, a lot of you taking low dose aspirin, sometimes called baby aspirin, to prevent a heart attack or a stroke, got a news alert on your phone saying this advice had been reversed, leaving you wondering if you should stop taking your daily pill. But there's more to this story and today we are diving in. Joining me to give us some insights into the breaking news is someone I trust to monitor all health news for the show, Dr. Michael Crouppen. He's head of our medical unit and a preventive medicine expert. So this, you know, not that anyone would ever just look at the headline and not read the article, but just in case one of our viewers only looked at the headline, what's the story behind the story? Yeah, so there's new guidance, new draft guidance from the U.S. Preventive Services Task Force that is pulling back in a big way the advice about who should be taking a daily aspirin for prevention of cardiovascular disease. And specifically, we're talking about something called primary prevention and that's trying to prevent people from getting their first heart attack or stroke. And so, as you know, for a long time, we've just been giving out aspirin pretty freely for that purpose. But over the last several years, and we've talked about it a lot, there has been a lot of new studies showing there are more risks than we thought to this practice. And so now this expert panel, which is charged with sort of weighing the risks and the benefits of these preventive services, saying the risks actually outweigh the benefits for people 60 and older and for people younger than that, that balance has become much less clear. A lot of patients are out there hanging right on what they should do in the meantime while they're waiting for this all to play out. So let's break down the risks, why this came down, and why this advice is being changed now. So it all starts with the rewards. What's the benefit of taking the aspirin, right? So here's a woman, let's say, who's got a high risk for having a heart attack or a stroke in the future. Her heart is pumping just fine right now, but we can go close into these arteries on the top of the heart. These are called coronary arteries. You're going to see that there's a little cholesterol buildup that's starting to occur right here, getting thicker and thicker. The blood's squeezing past, but then watch what happens. A little plaque ruptures. Now you form a blood clot on top of that area because it's a cut, right? Whenever you have a cut, you form a clot, and you can block off all the blood flow. When that happens, on the surface of the heart, you'll see it here. It's like someone punched the heart. You start getting a bruise. This part of the heart muscle may begin to die. So like tens of millions of Americans, her doctor gave her a low-dose aspirin to take every day. Why? Because taking an aspirin, there she goes right there. You can chew it, by the way, if you're having an acute problem. Most of us just swallow it, right? But now when you have that same problem occur again, the blood's flowing through the artery on top of the heart. There's the big plaque, but watch what happens when you rupture the plaque. When you get a little cut in your plaque, boom! Does it form a big clot? No. They don't clump as much clot. The platelets don't cause the same kinds of problems. That leaves a little bit of room for blood to squeeze by, right, to supply the oxygen and nutrients to the blood muscle, to the muscle, and so the doctors can prevent this from becoming a huge catastrophe. It's a low-cost, easy prevention step that has many of you at home feeling more comfortable on life because you've relied on it, but there's a catch. It may be important for people like Sharon who's joining us today. You've been taking a low-dose aspirin for a while. Yes. Thoughts on this news? I was extremely shocked. It blew my mind. I was like, wow, stop taking aspirin. I've been taking aspirin for over 10 years now. Yeah, we've been talking about it for even longer than that. I remember bringing it up on an Oprah show way back when. It was pretty much standard philosophy, but then over the last couple years, it's been changing, and I'll show you why. First of all, what does aspirin do? All right, so lift that up. What do you think about that little sludgy stuff? It's nice and thick. You like vampire movies? Love, love, love vampire movies. So this is what your blood can look like if it's a little thicker than usual, and some conditions can make it worse. Here's the blood vessels in your body. There they are. Tons of them going everywhere. They're in your heart. They're in your brain. They're also in your intestines. They're everywhere. So go ahead and pour that sludge in there. Now, you might notice there's a little bit of a hassle, right? Yeah, it's really thick. You can stop. That's all you're going to get in there. You notice it's barely getting down to the tissues, right? It's up here, and it's stuck. So one of the arguments, because you don't want this happening, like I just showed you that animation, is you take an aspirin, all right? So instead of popping a pill in there, I'm going to pretend that's the aspirin. Go ahead. Now, the aspirin will thin your blood. Go ahead and pour it right in here. And when you take the aspirin into your bloodstream, you thin the blood. You can pour more than that. You can be more judicious, right? And what that does very gently is it creates... Keep going. You can take, you know, as much aspirin as you need to to get the blood to the right consistency. That's perfect. Now, what you'll notice is it's not quite as thick, is it? No, it's Kool-Aid now. It's Kool-Aid. So go ahead and pour that in there. Now that you've taken aspirin, your blood's a lot thinner. So now all the blood goes down where it's supposed to go into the tissues. And let's pretend that this is your brain, right? Or your stomach. You're going to pour it all the way in there, right? Yeah, because your body's going to want all the nutrients you can get. But here's the catch. When you fill up your body with blood like it's supposed to, it's a lot thinner. That's perfect. It's a lot thinner than it was before. Now, if you get any small little hole, right? Because your gut, your brain, these are sensitive areas. Any small little hole, and now you'll start to have bleeding. And that bleeding will start pouring out of here at different rates. And when that happens, ooh, you now have a hemorrhage. And this is the problem that the doctors have identified over the last couple of years. You get hemorrhage in places that are dangerous. Like, for example, in your brain, where there's no place for the blood to go. Or in your stomach, where it can all come pouring out. And you may get more bleeding problems than you prevent heart attacks. Wow. That's the balancing act. Amazing. So I'm going to give you the aspirin, but don't take it yet. All right. We can talk a bit more. All right. So let me go back to Dr. Crouppe. So I think we're seeing that the balancing act between the benefits and the potential complications are not as clearly beneficial to people. That's right. But there's also a whole partisan argument that was really high for a while, which is the possibility that could actually help the colon cancer. And that's sort of, in this new draft, it's dropped off. They don't talk about it. There's no mention of cancer really at all. Yeah. So that's really interesting. In 2016, when the last set of recommendations came out, it was big news that taking a daily aspirin could also help prevent colon cancer. We talked about it a lot on this show. But the studies changed. The data changes. So they've been following that same cohort that that original recommendation was based on. And now they see, after a longer period of time, that benefit's just not there. And so it's out of the guidance. So break it down for us. Who should stop taking low-dose aspirin right now? Well, right now, I don't think anyone should stop taking it just based on this story, because everyone's risks are different. So if you're in one of the age groups that we're talking about here, age 40 and up, you should talk to your doctor and find out if you should stop or keep going. But generally speaking, high-level, the recommendation still stands, I gather, right, that if you're on a daily aspirin because you had a heart attack, for example, or a stroke, you should stay on it? That's right. This doesn't apply to people like that, because this is about primary prevention. So if you've had a heart attack or a stroke, you don't come off your aspirin. And if you're off the curve, let's say you're older, let's say over 60, right, then most of those people probably aren't going to be getting aspirin for primary prevention if this data holds true. That's right. Not anymore. And then the group that's 40 to 59, they may be surprised because they might still hear from their doctors that they need to be on that daily aspirin if they have the right risk and benefit calculation there, because according to the task force, they could still benefit from this. And what's really extra interesting about this is in past guidance, we didn't talk about these young people who were in their 40s. In this group, it started at an older age group, so that's a big change. I think one of the big breakthrough ideas, this is important, because the question is, why does medicine have these massive changes in recommendations? It's not a little thing, it's a 180-degree change, right? We have to adjust because the data adjusts, right? We get new information. Just like with COVID, we have to keep changing our minds. It seems like people are going left and right and getting whiplash from the changing recommendations, but you've got to be able to make these 180-degree turns, which are frustrating because they're part of the scientific process. As an example, the early data showing that aspirin was beneficial occurred with mostly male doctors, and the risk factors that we could change weren't that good, right? We couldn't change your blood pressure as much, or your cholesterol as much, or your diabetes as much. Now we've got great pills to do that, so the benefit of thinking that blood has gone down quite a bit. So doctors should always be given the best advice based on the current data, right? We're always willing to learn. That's our job, right? Actually, our job is to empower you. It's to get you to do what you think is best for your body, not to chastise you, finger-wag at you for not following all of our rules.