For over 30 years, many U.S. adults have taken a daily dose of aspirin to prevent heart disease, as previously recommended by many health professionals. However, in 2021, the U.S. Preventative Services Task Force (USPSTF) changed its recommendations regarding aspirin and heart disease. The USPSTF now recommends that adults aged 60 and over not initiate the use of low-dose aspirin to prevent cardiovascular disease, and that adults ages 40–50 only initiate low-dose aspirin if they are at elevated risk of cardiovascular disease.
The recommendations changed because, as with most drugs, aspirin has risks that may outweigh its benefits. Aspirin increases the risk of internal bleeding. While the change in risk is relatively small, the overall risk of internal bleeding also increases with age — for older adults, taking daily aspirin may push the risk high enough that it outweighs the cardiovascular benefits provided by aspirin. Furthermore, recent clinical trials have shown that low-dose aspirin raises the risk or hemorrhage in older adults but does little to lower the risk of cardiovascular disease.
The effects of aspirin on cardiovascular disease risk were striking when they first appeared in 1988; a clinical trial involving over 22,000 male physicians showed that low-dose aspirin decreased the risk of a heart attack by nearly half. However, the current science suggests much smaller benefits. This is likely due to the evolving study population; far fewer people smoke today, and there are now much better treatments for other risk factors for heart disease, like high blood pressure and cholesterol.
So, what is the best course of action now? First, always talk to your healthcare provider before starting or stopping the use of any medications. If you are under 40 or over 60 with no major heart-related risk factors, it is unlikely that you should begin taking low-dose daily aspirin. If you are between those ages and have an increased risk of cardiovascular disease, your healthcare provider may recommend daily aspirin. If you previously took aspirin to prevent heart disease but it is no longer recommended, discontinuation has no known added risk. The evidence suggests that this group should stop their daily aspirin doses, but only after consulting their doctors.
Sources: U.S. Preventative Services Task Force, Am J Med, New England J Med, NYT, Columbia
