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

Health experts warn bleeding risks can outweigh cardiovascular benefits for some, but new research shows many older adults are unaware

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If you’re considering taking a daily aspirin to help prevent a heart attack or stroke from ever occurring, know this: The U.S. Preventive Services Task Force (USPSTF) says that adults 60 and older should not start taking aspirin to lower their risk of a first heart attack or stroke. It also says that 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.

This guidance, published in 2022 in JAMA, is based on accumulating research suggesting that 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,” USPSTF member Chien-Wen Tseng, M.D., said in a statement.

People who are 40 to 59 and 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. Doctors should take into account a patient’s cardiovascular disease risk and chance of bleeding, among other factors, the task force said.

It’s important to note that the USPSTF 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.

Many older adults are not following new recommendations

New research, however, finds that many older adults are not heeding this advice. According to a March 2024 report from the National Poll on Healthy Aging, sponsored by AARP, 14 percent of adults ages 50 to 80 are taking aspirin regularly even though they have no history of cardiovascular issues. Twenty percent of them said they started doing it on their own, and 5 percent began taking aspirin based on the recommendation of family or friends. The poll also found that 31 percent of older adults who take aspirin don’t know about the associated bleeding risk.

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One possible explanation for the disconnect: The latest USPSTF guidance pivots from previous recommendations issued in 2016, which suggested that people ages 50 to 59 with a certain level of risk for cardiovascular disease and a low risk for bleeding take a daily low-dose aspirin to reduce the likelihood of suffering a heart attack or stroke. The old recommendations also said that 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.

“Aspirin is no longer a one-size-fits-all preventive tool for older adults, which for decades it was touted as,” Jordan Schaefer, M.D., a hematologist at Michigan Medicine who worked with the poll team, said in a statement. “This poll shows we have a long way to go to make sure aspirin use is consistent with current knowledge.”

Poll director Jeffrey Kullgren, M.D., said the report’s findings should encourage more conversations between health care providers and patients about what works best for them. 

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“We continue to urge clinicians to be extremely selective when prescribing aspirin for adults without known cardiovascular disease,” Donald M. Lloyd-Jones, M.D., president of the American Heart Association, 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.

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.

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

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