The American Heart Association (AHA) no longer recommends that adults who have not had a heart attack or stroke take a daily low-dose aspirin to prevent one from occurring.
Doing so could cause more harm than good, and new research reinforces this stance.
Aspirin thins the blood and helps prevent clots from forming, which can be lifesaving in the event of a heart attack or stroke. This is why doctors often prescribe a low-dose aspirin regimen to people with a history of cardiovascular disease.
But the drug's anticlotting ability also increases the risk of bleeding in the brain and gut, and experts have found that “the harms exceed the benefits” in most people who do not have a clotting disorder and who are at low risk for heart attack and stroke, says Donna Arnett, dean of the University of Kentucky College of Public Health and former AHA president.
A recent review published in the journal Family Practice reports that for every 1,200 adults who take aspirin for five years to prevent their first heart attack or stroke, four fewer heart attacks and three fewer strokes will occur, but the group will have three more brain bleeds and eight major bleeding events.
The “balance of benefits and harms has changed” since older studies that established aspirin as the go-to method for preventing cardiovascular events, says Mark Ebell, the study's co-author.
"That was an era before widespread use of statin drugs, before we did a better job of controlling blood pressure” — and both of those reduce the likelihood of heart attack or stroke, he says.
The benefits of aspirin still outweigh the risks in people with a history of cardiovascular disease. However, patients should talk to their doctor before taking any medication, including low-dose aspirin, says Arnett, an epidemiologist.
"If the person has a history of bleeding risk, or a family history of bleeding risk, that may weigh into the shared decision-making between the patient and the doctor,” she says.
If your doctor has put you on an aspirin regimen and you do not have a history of heart attack or stroke, do not stop taking the aspirin, says Ebell, a family physician and professor of epidemiology at the University of Georgia College of Public Health.
Instead, ask your doctor if you still need it. You may be taking aspirin for another preventive reason.
Before the new aspirin recommendations were issued earlier this year, nearly 30 million Americans age 40 and older without cardiovascular disease reported taking aspirin daily to prevent a heart attack or stroke, according to 2017 data that Harvard doctors compiled.
More than 6 million were doing so without consulting their doctor, and nearly half of Americans 70 and older with no history of cardiovascular disease were taking daily aspirin despite warnings against the practice, the same report found.
Both the AHA and the American College of Cardiology emphasize the role of a healthy lifestyle in heart disease prevention. Adults should consume a healthy diet and engage in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity, the groups say.