New guideline: ASA no longer recommended to prevent first stroke, heart disease

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A new Heart & Stroke guideline published today in the Canadian Medical Association Journal does not recommend taking ASA (Acetylsalicylic acid) as a preventive measure for those who do not have a history of stroke or heart or vascular disease, a change to a decades-old common practice.

The recommendations are based on strong new research that indicates taking ASA (brand names include Aspirin, Entrophen, Novasen) daily could potentially do more harm than good for those at low risk for stroke, heart or vascular disease, by causing serious side effects such as internal bleeding.

“The new recommendations only apply to those who have not had a stroke, heart condition, or peripheral arterial disease. It is still strongly recommended that anyone with a history of stroke, or heart or vascular disease continue to take low-dose, daily ASA to prevent another event from occurring if they have been advised to do so by a health professional,” says Theodore Wein, neurologist at McGill University and the chair of the Heart & Stroke writing group that developed the new guideline.

The recommendations could have far-reaching effects. Based on the results of a new poll commissioned by Heart & Stroke, 5.3 million Canadian adults are taking ASA to prevent heart disease or stroke, of whom 2.4 million do so without being directed to by their doctor.

“We are urging Canadians to talk to their doctor or health care professional to weigh the risks and benefits before deciding to start, continue or stop taking ASA daily to prevent stroke, heart disease or vascular disease,” says Patrice Lindsay, director, Systems Change and Stroke Program, Heart & Stroke. “It is an important personal health decision that should be informed by the recent research and made in consultation with health care professionals.”

This new guideline is a shift from a long-standing conventional belief on the part of the public and health care providers. People in Canada need to be made aware of the potential risks and how they may outweigh the potential benefits for millions of individuals.

The American Heart Association has similarly revised its ASA recommendations based on this new evidence. The recommendations were developed in collaboration with the Canadian Stroke Consortium and have been endorsed by the Canadian Stroke Consortium, the Canadian Cardiovascular Society, Thrombosis Canada, Canadian Society of Hospital Pharmacists, Canadian Pharmacists Association and the Nurse Practitioners Association of Ontario.

Almost 80% of premature heart disease and stroke are preventable through healthy lifestyle behaviours such as diet, being tobacco-free and physical activity. Many risk factors, such as high blood pressure, can be managed.

These new recommendations have been released as part of the Heart & Stroke Canadian Stroke Best Practice Recommendations.

Read the new guideline at heartandstroke.ca/ASA


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