Guidelines Advise Fewer People to Take Aspirin to Prevent Heart Problems
You’re not getting any younger, and you don’t want to end up like your dad, who died of heart disease. So you go to the drugstore, buy a bottle of baby aspirin, and start taking one every day to help protect yourself.
It’s a no-brainer, right?
Well, not so fast.
New guidelines from an influential group of experts say that a daily low-dose aspirin (80 to 160 milligrams) might slightly reduce the chances of a first heart attack or stroke for some people in their 40s and 50s who are at high risk of having one.
But for people ages 60 and up, recent research shows that the extra risk of bleeding as a result of taking aspirin outweighs any potential benefits.
“Patients ask what they can do to prevent heart disease, and we used to say perhaps take a low-dose aspirin a day, and now we’re not going to recommend that,” says Angela Nicholas, MD, a family physician and Chief Medical Officer at Einstein Medical Center Montgomery.
It’s important to discuss your potential risk of heart disease with your doctor, says Sumeet Mainigi, MD, Chair of Cardiology at the Einstein Healthcare Network.
“A lot of patients just began to take low-dose aspirin on their own,” he says. “But we need to make sure that a worthwhile discussion takes place about the pros and cons.”
All of the new aspirin recommendations, published April 26 by the US Preventive Services Task Force (USPSTF), apply to people who don’t have known heart and blood vessel (cardiovascular) disease and have never had a heart attack or stroke.
For most of those who have had such an event, aspirin is still highly recommended, Dr. Mainigi notes. “That group clearly benefits as long as there’s not a reason not to be on aspirin.”
Clot Prevention vs. Bleeding Risk
Aspirin helps to reduce the risk of blood clots, which can cause a heart attack or an ischemic stroke (the most common type) by blocking an artery or another blood vessel, especially one already narrowed by a waxy buildup known as plaque.
But the down side of preventing clots is that aspirin also increases the risk of bleeding in the stomach, the brain or elsewhere.
The USPSTF weighed these potential risks and benefits, illuminated by recent research, in updating its previous aspirin guidelines from 2016.
Here’s what the new guidelines say:
- If you are age 40 to 59, have not had a heart attack or stroke, and have at least a 10% chance of developing heart and blood vessel (cardiovascular) disease in the next 10 years, talk with your doctor about whether a daily low-dose aspirin might benefit you. (Find out your risk with this online tool.)
- If you are age 60 or older and have not had a heart attack or stroke, you should not begin taking aspirin to prevent one.
If you are already taking aspirin, talk with your doctor about whether you should stop.
Dr. Mainigi notes that the interest in recommending aspirin began in the 1990s with the discovery that taking an aspirin during a heart attack could help break up the clot causing the attack.
Believing aspirin to be a safe drug, doctors started recommending it to prevent second heart attacks or strokes – and even first-time events. In other cases, patients started taking it on their own.
But recent research has cast doubt on the benefits of aspirin for those without a previous heart attack or stroke. “I personally have not been as aggressive in prescribing prophylactic [preventive] aspirin for some time,” Dr. Mainigi says.
In reporting its decision, the USPSTF cited research that showed a small reduction (about 12%) in the risk of nonfatal heart attack or stroke among people in their 40s through 70s who took aspirin regularly.
But taking aspirin increased the risk of bleeding 58% in the stomach and intestines and 31% in the skull or brain. Because bleeding risk increases with age, the task force recommended against preventive aspirin use for people ages 60 or older.
Some research in the past has suggested that taking a daily aspirin may reduce the risk of colorectal cancer. But among the research studies cited in the USPSTF guidelines, some showed a benefit, while others did not.
Dr. Mainigi and Dr. Nicholas say they are unlikely to recommend daily aspirin to prevent a first heart attack or stroke because there are so many other options that are proven to help.
Individuals who have other conditions that increase their risk of bleeding are especially unlikely to benefit from aspirin, Dr. Mainigi says.
“There are a lot of things that help to prevent heart disease,” Dr. Nicholas says. “That includes eating healthy, exercising for 150 minutes a week and, if your cholesterol places you at high risk for your age and risk factors, taking a statin. We know cholesterol medicine does reduce your risk for certain conditions.”
Dr. Mainigi says he might recommend aspirin only if those steps are unsuccessful.