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Don’t Start Aspirin Regimen to Prevent Heart Attack, Stroke After Turning 60

In final recommendation, health experts warn bleeding risks can outweigh cardiovascular benefits for some

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Adults 60 and older should not start taking aspirin to lower their risk of a first heart attack or stroke, according to final recommendations issued April 26, 2022, by the U.S. Preventive Services Task Force (USPSTF). And people ages 40 to 59 who are at higher risk for cardiovascular disease but don’t have a history of it should talk to a health care provider before starting an aspirin regimen, the group of medical experts says.

This latest guidance, published in JAMA Network, mirrors draft recommendations proposed by the group in October 2021 and is based on accumulating research that suggests the potential harms of taking aspirin can outweigh the benefits. Daily aspirin use has been shown to lower the chance of having a first heart attack or stroke, both of which are leading causes of death in the U.S. But the over-the-counter medication, which thins the blood and prevents clots from forming, can also lead to life-threatening bleeding in the stomach, intestines and brain — a risk that increases with age.

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“The latest evidence is clear: Starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” task force member Chien-Wen Tseng, M.D., said in a statement.

People who are 40 to 59 years old and are at higher risk for cardiovascular disease may benefit from starting to take aspirin to prevent future incidents, but they should “decide together with their health care professional if starting aspirin is right for them, because daily aspirin use does come with possible serious harms,” task force member John Wong, M.D., said in a news release.

When deciding whether adults between 40 and 59 should start taking aspirin to prevent a first heart attack or stroke, health care professionals should take into account the patient’s cardiovascular disease risk and chance of bleeding, among other factors, the task force says.

It’s important to note that the new recommendations do not apply to people who already have heart disease, have had a stroke or are already on an aspirin regimen. “Anyone who already takes aspirin and has questions about it should speak with their health care professional,” Wong said. 

Study Points to Increased Risks for Brain Bleeds 

A study published July 26, 2023, in JAMA Network Open found that older adults without a history of cardiovascular disease who took a daily low-dose aspirin had a significantly higher risk of experiencing bleeding in the brain. Meanwhile, their risk of stroke did not decrease while on the medication. “The lack of benefit and potential risks from aspirin in primary stroke prevention provide further evidence in support of the recently published draft recommendation of the USPSTF against the routine prescribing of low-dose aspirin as a primary prevention measure, especially in older persons,” the study’s authors write.

New advice differs from previous recommendations

The latest guidance pivots from recommendations issued in 2016, which suggested that people ages 50 to 59 with a risk of cardiovascular disease that is 10 percent or greater in the next decade and a low risk for bleeding take a daily low-dose aspirin (100 milligrams a day or less) to reduce the likelihood of suffering a heart attack or stroke. The decision to start taking aspirin for preventive reasons should be “an individual one” for adults ages 60 to 69 who are at risk for cardiovascular disease, the 2016 recommendations said.

The new recommendations align more closely with 2019 guidance from the American Heart Association and the American College of Cardiology.

Even still, aspirin use for the primary prevention of cardiovascular-related incidents is common in the U.S., “and is often self-initiated rather than recommended by a physician,” the task force’s October 2021 report says. A 2017 National Health Interview Survey found that 23.4 percent of adults age 40 or older and without cardiovascular disease took aspirin for primary prevention; among adults 60 to 69 years old, 34.7 percent reported aspirin use.

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“We continue to urge clinicians to be extremely selective when prescribing aspirin for adults without known cardiovascular disease,” American Heart Association President Donald M. Lloyd-Jones, M.D., said in a news release. “For example, people with higher risk for gastric or intracerebral bleeding should not take aspirin to prevent a [cardiovascular] event. Aspirin should be limited to only those adults at the highest risk for cardiovascular disease due to the presence and severity of other risk factors, such as smoking, hypertension, type 2 diabetes, high cholesterol or significant family history, who also have a very low risk of bleeding.”

According to the American Heart Association, nearly half of American adults have some type of cardiovascular disease — a catchall term for conditions that affect the heart and blood vessels. Cardiovascular disease accounts for more than 1 in 4 deaths in the U.S. High blood pressure is the leading risk factor for the disease; diabetes, obesity and age can also increase risk.

The majority of all cardiovascular events may be prevented by managing risk factors and adopting healthy habits like exercising, not smoking and eating nutritious foods, Lloyd-Jones said. “The scientific evidence continues to confirm healthy lifestyle habits and effectively managing blood pressure and cholesterol are the top ways to prevent a first heart attack or stroke, not low-dose aspirin,” he added.

Editor’s note: This story, published October 12, 2021, has been updated with new information. 

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