The recommendation from the U.S. Preventive Services Task Force said that people aged 40 to 59 who are at higher risk for CVD (cardiovascular disease) but do not have a history of it should decide with their healthcare professional whether  to start taking aspirin as a preventive measure if they have not had a first heart attack or stroke.

People over 60 should not start taking aspirin to prevent a first heart attack or stroke, but the task force emphasized that this applies only to patients who have not started taking aspirin to prevent CVD and have no history of it. The task force emphasized also that people in this age group who are already taking aspirin should continue to do so.

Heart disease and stroke are leading causes of mortality in the United States, accounting for more than one in

four deaths. While daily aspirin use has been shown to lower the chance of having a first heart attack or stroke,

it can also cause harm. The most serious potential harm is bleeding in the stomach, intestines, and brain, also

known as internal bleeding.

“People who are 40 to 59 years old and who don’t have a history of CVD but are at higher risk may benefit from

starting to take aspirin to prevent a first heart attack or stroke,” says Task Force member John Wong, M.D. “It’s

important that they decide together with their healthcare professional if starting aspirin is right for them

because daily aspirin use does come with possible serious harms.”

When deciding whether patients ages 40 to 59 should start taking aspirin to prevent a first heart attack or

stroke, healthcare professionals should take into account the patient’s CVD risk, chance of bleeding, and other

factors. The Task Force encourages shared decision making between healthcare professionals and patients so

that the decision made is best for a patient’s health and in line with the patient’s values and preferences.

“Based on current evidence, the Task Force recommends against people 60 and older starting to take aspirin

to prevent a first heart attack or stroke,” says Task Force vice chair Michael Barry, M.D. “Because the chance of

internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age

group.”

Importantly, these recommendations are not for people who already have heart disease, have had a stroke, or

are already taking aspirin; these people should talk to their healthcare professional about their individual

circumstances. “We want to emphasize that these recommendations are focused on starting aspirin to prevent

a first heart attack or stroke. Anyone who already takes aspirin and has questions about it should speak with

their healthcare professional,” Wong added.

The final recommendations were published in the Journal of the American Medical Association. The recommendation, along with an evidence summary, can be found on the task force website.  

The Task Force’s final recommendation statement and corresponding evidence summary and modeling study

have been published online in the Journal of the American Medical Association, as well as on the Task Force

website; click here.

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based

medicine that works to improve the health of people nationwide by making evidence-based

recommendations about clinical preventive services such as screenings, counseling services, and preventive

medications.

Wong is interim chief scientific officer, vice chair for Academic Affairs, chief of the Division of Clinical

Decision Making, and a primary care clinician at Tufts Medical Center. He is a professor of medicine at Tufts

University School of Medicine.

Barry is the director of the Informed Medical Decisions Program in the Health Decision Sciences Center at

Massachusetts General Hospital. He is also a professor of medicine at Harvard Medical School and a clinician at

Massachusetts General Hospital.

Avocados contain dietary fiber, unsaturated fats, especially monounsaturated fat (healthy fats), and other favorable components that have been associated with good cardiovascular health. Clinical trials have previously found avocados have a positive impact on cardiovascular risk factors including high cholesterol.

Researchers believe this is the first, large, prospective study to support the positive association between higher avocado consumption and lower cardiovascular events, such as coronary heart disease and stroke.

“Our study provides further evidence that the intake of plant-sourced unsaturated fats can improve diet quality and is an important component in cardiovascular disease prevention,” said Lorena S. Pacheco, Ph.D., M.P.H., R.D.N., lead author of the study and a postdoctoral research fellow in the nutrition department at the Harvard T.H. Chan School of Public Health in Boston. “These are particularly notable findings since the consumption of avocados has risen steeply in the U.S. in the last 20 years, according to data from the U.S. Department of Agriculture.”

For 30 years, researchers followed more than 68,780 women (ages 30 to 55 years) from the Nurses’ Health Study and more than 41,700 men (ages 40 to 75 years) from the Health Professionals Follow-up Study. All study participants were free of cancer, coronary heart disease and stroke at the start of the study and living in the United States. Researchers documented 9,185 coronary heart disease events and 5,290 strokes during more than 30 years of follow-up. Researchers assessed participants’ diet using food frequency questionnaires given at the beginning of the study and then every four years. They calculated avocado intake from a questionnaire item that asked about the amount consumed and frequency. One serving equaled half of an avocado or a half cup of avocado.

The analysis found:

After considering a wide range of cardiovascular risk factors and overall diet, study participants who ate at least two servings of avocado each week had a 16% lower risk of cardiovascular disease and a 21% lower risk of coronary heart disease, compared to those who never or rarely ate avocados.

Based on statistical modeling, replacing half a serving daily of margarine, butter, egg, yogurt, cheese or processed meats such as bacon with the same amount of avocado was associated with a 16% to 22% lower risk of cardiovascular disease events.

Substituting half a serving a day of avocado for the equivalent amount of olive oil, nuts and other plant oils showed no additional benefit.

No significant associations were noted in relation to stroke risk and how much avocado was eaten.

The study’s results provide additional guidance for health care professionals to share. Offering the suggestion to “replace certain spreads and saturated fat-containing foods, such as cheese and processed meats, with avocado is something physicians and other health care practitioners such as registered dietitians can do when they meet with patients, especially since avocado is a well-accepted food,” Pacheco said.

The study aligns with the AHA’s guidance to follow the Mediterranean diet – a dietary pattern focused on fruits, vegetables, grains, beans, fish and other healthy foods and plant-based fats such as olive, canola, sesame and other non-tropical oils.

“These findings are significant because a healthy dietary pattern is the cornerstone for cardiovascular health. However, it can be difficult for many Americans to achieve and adhere to healthy eating patterns,” said Cheryl Anderson, Ph.D., M.P.H., FAHA, chair of the American Heart Association’s Council on Epidemiology and Prevention.

“We desperately need strategies to improve intake of AHA-recommended healthy diets — such as the Mediterranean diet — that are rich in vegetables and fruits,” said Anderson, who is professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego. “Although no one food is the solution to routinely eating a healthy diet, this study is evidence that avocados have possible health benefits. This is promising because it is a food item that is popular, accessible, desirable and easy to include in meals eaten by many Americans at home and in restaurants.”

The study is observational, so a direct cause and effect cannot be proved. Two other limitations of the research involve data collection and the composition of the study population. The study analyses may be affected by  measurement errors  because dietary consumption was self-reported. Participants were mostly white nurses and health care professionals, so these results may not apply to other groups.