Why Does Medical Advice Often Change? Doctors Explain - The New York Times
Oct 22, 2021 2 mins, 6 secs
Preventive Services Task Force, seemed to reverse decades of medical practice, announcing that daily low-dose aspirin should no longer be automatically recommended in middle age to prevent heart attack.

Vitamin megadoses to lower cancer and heart risk: For years, doctors believed various vitamins could lower risk for cancer and heart disease, but a number of studies showed just the opposite.

A study of vitamin E and selenium, thought to protect against prostate cancer, increased risk for the disease.

While daily aspirin can lower risk of heart attack or stroke, it can also increase risk for internal bleeding.

Several experts say the new guidance from the Preventive Services Task Force to curb aspirin use is not a true medical reversal and should be viewed as updated advice replacing outdated guidance, which is why the panel exists in the first place.

For people who have had a heart attack, stroke or other major cardiovascular issue, the case for using aspirin to protect them from a second event remains strong.

The new Preventive Services Task Force guidelines don’t change that advice.

What has changed is the guidance for using aspirin to prevent a first heart attack or stroke.

The study was stopped early because the benefit in the aspirin group was so drastic — cutting heart attack risk by nearly half.

As a result of the physician study and other research, the task force began updating its aspirin advice.

But by 2016, the task force had recommended low-dose aspirin for adults 50 to 59 at risk of heart problems.

Fewer people smoke, and doctors have better treatments to control diabetes, high blood pressure and cholesterol, issues that all affect risk for heart attack and stroke.

Aspirin still works to protect the heart, but doctors say the benefits aren’t as pronounced now that other more effective treatments have emerged.

Three major studies of aspirin influenced the task force advice this year.

A 2018 study of more than 19,000 healthy people 65 and older showed that regular low-dose aspirin use significantly raised bleeding risk and didn’t significantly lower risk of heart problems compared with a placebo.

A 2018 study of aspirin use in 15,480 people with diabetes found a benefit to the heart but also a significant bleeding risk.

As a result, the task force this month said that people 60 and older should definitely not start taking aspirin to prevent a first heart attack or stroke.

Cifu said the revised aspirin guidelines were a sign that the task force review process was working and should give people more confidence in the advice.


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