Once upon a time, bloodletting and lobotomies were common medical procedures. Cocaine was prescribed for depression, and doctors treated asthma with cigarettes. Conventional medical wisdom – fortunately for us – changes over time. The progress of science is cumulative: as we gather more evidence, we build upon our existing knowledge and abandon those practices for which there is little empirical support. Earlier this year, the United States Preventive Services Task Force (USPSTF), a volunteer panel of experts that issues evidence-based medical recommendations, updated their stance on daily aspirin use. 30 million Americans over the age of 40 take aspirin every day because of its supposed benefit of reducing the risk of heart disease. The USPSTF now cautions against such widespread use. They state that aspirin for certain populations may have a small benefit, but that it should not be taken daily by healthy people.
Aspirin works by preventing inflammatory processes in the body. It can also prevent blood platelets from aggregating, hence the potential benefits of aspirin for people with cardiovascular disease. In such patients, abnormal platelet aggregation can lead to heart attack and stroke. Low-dose aspirin can be helpful in blocking the production of platelets and reducing the rate of platelet clumping. However, for people with no history of cardiovascular disease, the risks of aspirin may outweigh the benefits. In particular, you may be increasing your risk of excess bleeding, stomach ulcers, and liver damage if you take aspirin every day.
The USPSTF recommends that adults between the ages of 40 and 59 with a 10% or greater risk of developing cardiovascular disease in the next ten years talk with their doctors about taking daily low-dose aspirin. They may see a small benefit from aspirin use, especially if they are not at an increased risk of bleeding. Adults 60 years of age or older with no history or risk of cardiovascular disease are not recommended to take daily low-dose aspirin, and older adults with increased risk of bleeding should avoid taking daily aspirin. As always, these are individual decisions that must be discussed with medical professionals.
For people who are concerned about cardiovascular disease but who do not want to or cannot take daily aspirin, what else can done to reduce their risk? Cardiovascular disease affects nearly half of American adults and is the number one cause of death in the US, so it’s clear that we must be vigilant about preventing it. Dr. Emelia Benjamin, professor of cardiology at Boston University, recommends focusing on the “Simple 7” – the American Heart Association’s 7 goals of eating a healthy diet, exercising, avoiding obesity, not smoking, and keeping blood pressure, cholesterol, and blood sugar within a healthy range. This is particularly important for non-white populations, who may suffer from precursor conditions such as hypertension and obesity. South Asians are more likely to die of heart disease than the general population, and Black and Hispanic adults are more likely to suffer from hypertension, diabetes, and obesity.
Cardiovascular disease will likely continue to be a leading cause of death in the aftermath of the pandemic, which undoubtedly had a negative impact on cardiovascular health. Not only can COVID-19 itself cause damage to the heart, but the unhealthy eating habits, increased consumption of alcohol, and lack of physical activity that resulted from quarantine affected our health profoundly. Dr. Donald Lloyd-Jones, president of the American Heart Association, said in an interview last year that medical professionals “have seen much of the progress [in preventing cardiovascular disease] go out the window since COVID-19 hit.” Another impact of the pandemic was missed medical visits, with many patients postponing regular check-ups with their doctors. The American Heart Association also found that many individuals who experienced a heart attack or stroke during the pandemic “did not seek urgent care out of fear of contracting COVID-19 in a hospital setting.”
Everyone can take steps to reduce their risk of cardiovascular disease, but with the pandemic now on the wane, it may take some time to break the bad habits many of us fell into. Recommitting ourselves to a healthy diet and daily exercise and avoiding smoking and other unhealthy behaviors can do wonders for our physical and mental health. Heart disease is an epidemic in the United States that requires no less attention than COVID-19, and by listening to our medical professionals and living better, we can regain the progress we were making before the pandemic in reducing cardiovascular disease.
