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New recommendations about aspirin, heart health and colon cancer have left many people confused. Here’s what you need to know.

For years, many doctors have recommended that people in their 50s start taking a low-dose aspirin every day to protect heart health and, more recently, to prevent colon cancer. So it was a shock this week when an independent panel made recommendations to curb aspirin use.

But don’t throw out your aspirin bottle just yet.

The draft recommendations^[1], which came from the U.S. Preventive Services Task Force, were aimed specifically at people who have not yet started taking aspirin daily. The independent panel of volunteer experts did not issue advice for people who are already taking an aspirin every day, and the news does not necessarily mean you should stop taking the drug if your doctor prescribed it. Check with your physician first to talk about the risks and benefits.

The concern among cardiologists is that news coverage of the aspirin recommendations has confused people at high risk who can still clearly benefit from the drug. Doctors often prescribe daily aspirin for “secondary prevention” as a way to lower the risk for people who’ve already had a heart attack or stroke, or who have had serious cardiac interventions like stents or bypass surgery.

Dr. Eric Topol, a cardiologist and professor of molecular medicine at Scripps Research in La Jolla, Calif., said he had already stopped recommending aspirin to prevent a first heart attack, but there are many people at high risk who still benefit from the drug.

“The data are unequivocal for secondary prevention,” Dr. Topol said.

So what should aspirin users and others worried about heart health do now? Here are answers to some common questions.

What’s the concern about the risks of aspirin?

Daily aspirin use has been shown to lower risk of heart attack or stroke, but aspirin can also increase the risk for bleeding in the brain, stomach and intestines. Although the absolute risk of a bleeding event is relatively low, the risk increases with age.

For some people at very high risk of a heart attack or stroke, the benefits of a daily aspirin may far outweigh the bleeding risk. For many others, aspirin will no longer be recommended.

What should people who are taking daily aspirin do now?

Talk to your doctor before quitting aspirin. The task force guidance was only for people who have not started using aspirin.

Many patients now taking aspirin may be advised to keep taking it, particularly those who’ve already had a heart attack or other cardiovascular issue. It’s also possible that your doctor will tell you to stop using aspirin as a result of the task force advice, but the decision will be based on your specific health risks.

What if I’m not taking aspirin and I’m worried about heart risk?

For people ages 40 to 59, the task force suggested that you talk to your doctor about daily aspirin use. Depending on your personal circumstances, your doctor may still recommend that you start taking aspirin because the benefits to heart health outweigh the risk. But for many people, doctors will most likely discourage daily aspirin use based on the task force guidelines. If you have a family history of heart disease or another risk factor, your doctor may prescribe a class of drugs called statins that lower cholesterol and risk for heart attack.

For people ages 60 and older, the guidance is more definitive. The task force stated clearly that people in this age group should not start taking aspirin to prevent a first heart attack or stroke.

I recently had a heart attack and now take aspirin daily. Has the advice for me changed?

No. The task force makes recommendations only about prevention, and it did not weigh in on issues of disease management for people who have already had a heart attack.

What did the panel say about aspirin and colon cancer?

In 2016, the task force had advised people in their 50s at risk for heart disease to take low-dose aspirin to prevent both cardiovascular disease and colon cancer. But the task force this year reviewed additional research and decided it needed more evidence to make a definitive recommendation. Some patients with genetic risk for colon cancer may still be advised by their doctors to take aspirin.

Dr. Sophie M. Balzora, a gastroenterologist at NYU Langone Health, said the new guidance was likely to confuse and even disappoint many patients who wanted to take aspirin to lower risk for colon cancer. The most important thing patients can do to lower risk for cancer is to follow guidelines for regular colon cancer screening, Dr. Balzora said. Last year, the Preventive Services Task Force recommended that adults should start screening for colorectal cancer routinely at the age of 45^[2], instead of waiting until 50.

“I tell patients that there are still things in your control aside from aspirin that you can do to lower risk,” Dr. Balzora said. “Not smoking, an active lifestyle, limiting alcohol, eating a high fiber diet, avoiding processed meats and red meats — that’s stuff we’ve known for a while. There are still a lot of other things to focus on.”

If my doctor tells me to stop taking aspirin, how long does the increased risk for bleeding last?

The low risk for bleeding disappears quickly once you stop taking aspirin, Dr. Topol said. “Aspirin’s effect on the platelets goes away within a week,” he said.

Read more:
Aspirin Use to Prevent 1st Heart Attack or Stroke Should Be Curtailed, U.S. Panel Says^[3]

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More from the Well newsletter

Ask me your questions about winter and Covid

With colder weather and the holidays approaching, we all need to start planning for our second pandemic winter. Although I’m optimistic and believe that we have the tools we need to stay safe (vaccines, home tests, masks, air cleaners), I know many people still have questions. I want to hear from you. Use our Ask Well form to send me your questions about Covid, the holidays and anything else on your mind. I’ll talk to the experts and answer as many questions as I can in a future newsletter.

Ask a question:
Complete the Ask Well form^[4]

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A wild escape from the news

We all need distractions from the daily news. This week, for me, it was the Wildlife Photographer of the Year winners. The photos are breathtaking, and the stories behind them are fascinating. You’ll see mating squid, the piercing stare of a lion after a kill, a larger-than-life Brazilian spider, the “magnificent five” cheetahs, a toucan eating a bat and an ornamental mosquito biting the photographer who captured the image.

The annual event from the Natural History Museum in London began in 1965 as a magazine competition and is now one of the world’s most prestigious photography awards, with more than 45,000 entries each year and a touring exhibition.

All of the photos will be exhibited at the Natural History Museum in London starting on Friday and continuing until June.

Explore the online gallery:
Wildlife Photographer of the Year^[5]

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The Week in Well

Here is some news you don’t want to miss:

• Christina Caron wants to hear from you. How do you spend a mental health day^[6]?

• Love listening to New York Times podcasts? Help us test a new audio product in beta and give us your thoughts to shape what it becomes. Visit nytimes.com/audio^[7] to join the beta.

• Anahad O’Connor talks about getting a microbiome test^[8].

• Jane Brody explains the benefits of cutting back on salt^[9].

• And of course, we’ve got the Weekly Health Quiz^[10].

Let’s keep the conversation going. Follow me on Facebook^[11] or Twitter^[12] for daily check-ins, or write to me at well_newsletter@nytimes.com^[13].

Stay well!

References

1. ^{^} draft recommendations (https://ift.tt/LCFGjT)
2. ^{^} at the age of 45 (www.nytimes.com)
3. ^{^} Aspirin Use to Prevent 1st Heart Attack or Stroke Should Be Curtailed, U.S. Panel Says (www.nytimes.com)
4. ^{^} Complete the Ask Well form (www.nytimes.com)
5. ^{^} Wildlife Photographer of the Year (www.nhm.ac.uk)
6. ^{^} How do you spend a mental health day (www.nytimes.com)
7. ^{^} nytimes.com/audio (nytimes.com)
8. ^{^} getting a microbiome test (www.nytimes.com)
9. ^{^} the benefits of cutting back on salt (www.nytimes.com)
10. ^{^} Weekly Health Quiz (www.nytimes.com)
11. ^{^} Facebook (www.facebook.com)
12. ^{^} Twitter (twitter.com)
13. ^{^} well_newsletter@nytimes.com (www.nytimes.com)

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