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Rethinking an Aspirin-a-Day

Millions of Americans take a low dose of aspirin daily in the hope of lowering their risk of heart attack or certain types of stroke.

But, says CBS News Medical Correspondent Dr. Jennifer Ashton, federal advisers have scaled back their recommendations about which people should be doing that, targeting a narrower group due to concerns about the added risk aspirin brings of intestinal bleeding, including bleeding ulcers.

The fear is that those aspirin side effects might outweigh its potential benefits when it's taken by many healthy or older people, Ashton explains.

The newest guidelines, from the U.S. Preventive Services Task Force spell out much more clearly than before when aspirin should be administered, Ashton says. The panel urged doctors to factor in conditions that could increase a patient's risk of bleeding from aspirin - risks that tend to rise with age.

Aspirin therapy for heart disease is still considered to be good medicine for many, many people, but what's changed about the recommendations?

New studies have come out since the task force's 2002 guidelines about low-dose aspirin therapy for heart patients. The updated recommendations say that age, gender and other risk factors should be considered before prescribing an aspirin regimen. Public officials are pointing to a narrower group of patients who should take the painkiller. Some of the new research points to differences in how aspirin affects men and women.

Who do the guidelines still say SHOULD take aspirin daily?

For most people who've had a heart attack or stroke, the new guidelines don't apply. Those people should CONTINUE TAKING ASPIRIN. And, a daily aspirin IS recommended for certain MEN, ages 45 to 79, with increased heart-attack risk. For WOMEN, the guidelines don't focus on heart attack risk. Instead, the task force recommends women take aspirin regularly if they are 55 to 79 and in danger of having a stroke -- the type caused by blood clot -- because aspirin inhibits blood-clotting action, possibly averting formation of a clot that could cut off oxygen to the brain and heart.

Who is NOT a good candidate?

Aspirin Therapy is NOT recommended for people 80 and older. They could potentially benefit more than younger people because of their higher risk of heart disease, but the harms are also greater because the risk of gastrointestinal bleeding increases with age. These guidelines don't recommend aspirin therapy for men under 45 and under and women 55 and under, because the incidence of heart attack and stroke is considered too low. But there are other factors that need to be considered when deciding on aspirin therapy.

What factors play a part in deciding who would get the most benefit from aspirin?

The more risk factors people have, the more likely they are to benefit from aspirin. Conditions to consider: high blood pressure, cholesterol levels, diabetes and family history. But again, all the potential benefits have to outweigh the potential harm of aspirin.

What are the risks from aspirin therapy?

No. 1 is the risk of gastrointestinal bleeding. Things like stomach ulcers. And some people with asthma should not take aspirin. Gastrointestinal bleeding is twice as high in men as in women and again, increases with age.

How much aspirin are we talking about?

There is no definitive science on this, but the most commonly used dose is 81 milligrams -- the equivalent of a baby aspirin.

What should a patient do if he or she is on low-dose aspirin?

Check with your doctor. Doctors can really tailor the new guidelines to individual patients.

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