By Jack Phillips
A new study found that a significant number of older Americans continue to use small doses of aspirin to prevent cardiovascular disease despite two major heart associations having reversed their guidance on the practice.
In a paper released on June 24 in the Annals of Internal Medicine, some 18.5 million adults aged 60 and older who have no cardiovascular disease reported taking a preventative aspirin in 2021. About 3.3 million of those individuals were taking daily aspirin without a doctor’s recommendation, it said.
For decades, a daily dose of 81 milligrams of aspirin was recommended by heart associations and physicians to reduce the chance of developing a heart attack, stroke, or another cardiovascular problem.
But in 2019, the American College of Cardiology and the American Heart Association changed their guidelines on daily aspirin usage, saying that it should only be taken infrequently because older adults can see an increased risk of developing internal bleeding. The daily aspirin practice is still recommended for individuals who have a high risk of a heart attack or stroke.
An independent panel of health officials known as the U.S. Preventive Services Task Force made a similar recommendation in 2022, coming after they suggested daily aspirin usage to combat a heart attack or stroke.
Older adults without heart disease shouldn’t take daily low-dose aspirin to prevent a first heart attack or stroke, the group said at the time. Bleeding risks for adults in their 60s and up who haven’t had a heart attack or stroke outweigh any potential benefits from aspirin, it said.
At the time, the panel said that there may be a small benefit for adults in their 40s who have no bleeding risks. For those in their 50s, the panel softened advice and said evidence of benefit is less clear.
A researcher involved in the study, Dr. Mohak Gupta of the Cleveland Clinic, suggested on social media that their findings on daily aspirin usage come “despite 2018 data showing net harm due to bleeding with routine use,” making note of a previous study cited by the American College of Cardiology and the American Heart Association to make their reversal.
In response to the Internal Medicine-published study, researcher Eric Topol noted on social media platform X “aspirin for primary prevention of cardiovascular disease has been shown to cause more bleeding than benefit in randomized trials over the past 5 years.”
Another researcher, University of California Los Angeles professor Robert Lufkin wrote that his team found similar results in a March 2024 survey, adding that “many” older Americans “often don’t discuss” the risk-versus-reward data of aspirin usage with their health care provider.
In that poll, one in four adults aged 50 to 80 reported taking aspirin on a regular basis, meaning three or more days in a typical week.
“While some older adults, especially those with a history of cardiovascular disease, benefit from regularly taking aspirin, other older adults may not and could even be harmed by regular use,” the survey said, noting that people with a history of cardiovascular disease are “generally recommended” to take aspirin on a regular basis.
Regardless of age, adults should talk with their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said U.S. Preventive Services Task Force member Dr. John Wong, a primary-care expert at Tufts Medical Center. “Aspirin use can cause serious harms, and risk increases with age,’’ he said in 2022.
Health officials say that aspirin irritates the lining of the stomach, triggering internal bleeding, ulcers, and gastrointestinal problems. Known as a blood thinner, aspirin can be dangerous for individuals who are at a high risk of bleeding.
Meanwhile, people who use aspirin and another blood thinner can also run the risk of developing adverse reactions. Common blood thinners include other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen as well as heart drugs like warfarin. Some common herbal supplements like turmeric, garlic, and ginger also thin the blood.
The study included 186,425 participants who are aged 40 years and older, representing around 150 million adults.
The Associated Press contributed to this report.
