Do you take a dose of baby aspirin once a day? Are you doing this under doctor’s orders or just because you heard it prevented heart attack or stroke?
There is growing evidence against taking a low-dose aspirin daily for preventing cardiovascular events. But many well-intentioned people still take daily aspirin. A 2019 report by Harvard researchers estimated that 29 million Americans are taking a daily aspirin for preventative heart health, including people with no history of heart disease or stroke. Over 6 million of those people are taking it without their doctor’s advice or knowledge. Should they be?
The participants in the Harvard study were all over 40 with no self-reported history of heart disease. Even so, the authors of that study concluded that “aspirin use in the United States is wide-spread among groups at risk for harm.” Recommendations on who should be taking low-dose aspirin, when and if they should start, and when they should stop taking it, are shifting.
In 2019, the American Heart Association recommendation was that aspirin should NOT be used on a routine basis in people 70 and over. This April, the US Preventive Services Task Force (USPSTF) changed its recommendations to an even lower age, advising that people over 60 should not start taking it as a preventative for heart-related events.
Why is the USPSTF worth listening to? The USPSTF is a panel of national experts in disease prevention who make evidence-based recommendations about clinical preventive services. They work under the auspices of both the Agency for Healthcare Research and Quality (AHRQ) and the US Department of Health and Human Services.
Looking at the recent research in both the risks and benefits of aspirin use to prevent cardiac-related events and stroke, the USPSTF found only a small net benefit to taking daily low-dose aspirin in people 40-59 years old who have a greater than 10% risk of cardiovascular disease (CVD) over the next 10 years. They also found that the small net benefit diminished with age, and was outweighed by the increased likelihood of problems related to bleeding.
Their conclusion? “Aspirin should be initiated selectively based on individual decision-making rather than routinely for all persons in the recommended age and CVD risk group.”
Initiating aspirin use over the age of 60 as a primary prevention against cardiovascular events had no net benefit at all, and could put patients at risk.
They recommend that using aspirin as a primary preventative for cardiac events should be based on an actual assessment of risk factors, including bleeding risk factors, which increase with age.
Speaking about the recommendations this spring, Dr. Eugene Wang, chair of the American College of Cardiology’s Prevention Section Leadership Council, said that the new recommendation DOES NOT apply to people with existing heart problems who are taking low-dose aspirin, such as patients who have had angioplasty, heart surgery, a stroke, heart attack, or arterial blockages. “For those patients, where aspirin is clearly beneficial, the recommendation does not change,” Yang said.
The American Heart Association says that the risks and benefits of taking aspirin for cardiovascular disease prevention vary for each person. Their conclusion? “You should not start aspirin on your own.” Demilade Adedinsewo, a cardiologist at the Mayo Clinic, said, “This information should just basically make you have a conversation with your physician.”
 Aspirin Use to Prevent Cardiovascular Disease US Preventive Services Task Force Recommendation Statement. April 26, 2022 JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983
Feature image by Heung Soon from Pixabay.