An aspirin a day keeps a heart attack away — that’s been the conventional thinking for most of the past 30 years among millions of Americans with no history of heart disease.
But a 2022 U.S. Preventive Services Task Force report in JAMA cautions heart-healthy people over 60 that starting to take a daily aspirin may present more risks than benefits.
The task-force report states “with moderate certainty” that taking aspirin for the primary prevention of cardiovascular disease (CVD) events in those over 60 years has “no net benefit.”
Such a shift in the prevailing recommendation could take time, though. “Aspirin therapy” for preventing a first heart attack became common in the 1990s. As of 2019, a third of Americans age 40 or older were taking aspirin as a CVD preventive measure, according to a 2021 study in the American Journal of Preventive Cardiology. Among those 70 or older, 45.6 percent took aspirin for primary prevention.
“Many people don’t even think of aspirin as medication — they think of it as more like a vitamin,” Amit Khera, MD, director of the preventive cardiology program at the University of Texas Southwestern Medical Center (who is not a task-force panelist), tells the New York Times. “But just because it’s over-the-counter doesn’t mean it’s not a drug with benefits and risks.”
The U.S. Preventive Services Task Force is an independent, volunteer panel of 16 experts in disease prevention and evidence-based medicine, and its recommendation is not an official U.S. Department of Health and Human Services position.
The task force last issued a recommendation approving low-dose aspirin use as a preventive measure for CVD in 2016. But the panel shifted its thinking after commissioning a systematic review as well as a modeling study to assess the balance of benefits and risks. This review included assessment of three recent clinical trials involving more than 47,000 older adults.
Two of the studies revealed no notable reduction in heart attacks or strokes among participants, but they did show an increased risk of internal bleeding. The third study, focused on people diagnosed with diabetes, reported a slightly lower risk of cardiovascular events along with a higher chance of bleeding.
Major internal bleeding occurred in only 1 percent or fewer of the trial subjects, notes Allan Brett, MD, an internist at the University of Colorado, in a JAMA editorial on the task force recommendations. But the risks increased among older participants.
“These are serious bleeds,” Brett explains. “They can require transfusions. They can put people in the hospital.”
For those ages 40 to 59, the decision to take low-dose aspirin for prevention of CVD “should be an individual one,” the task force states. “Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit.”
If you’ve been taking a daily aspirin as a preventive measure, Khera suggests consulting with your doctor about discontinuing the regimen. But don’t stress about it, he adds. “For people [who are] generally healthy, with few risk factors, it’s reasonable to just stop.”
This was originally written by Experience Life deputy editor Craig Cox and appeared as “A Daily Aspirin May Bring More Risks Than Benefits” in the September 2022 issue of Experience Life.