Recent data reveals that as many as one in three older adults without a history of cardiovascular disease are still taking daily low-dose aspirin in an attempt to reduce their risk of heart attack, stroke, or other cardiovascular events.
This statistic, uncovered in a new survey, highlights a concerning trend: despite evolving guidelines, many people continue to take aspirin without understanding the potential risks.
Dr. Mohak Gupta, a cardiology fellow at Houston Methodist Hospital and coauthor of the study, warns that this practice may do more harm than good for many older adults. He points out that the risk of serious side effects, such as bleeding, often outweighs the potential cardiovascular benefits for this age group.
As Dr. Gupta and his coauthors emphasize, there is a growing need for healthcare providers to actively ask patients about their aspirin use and provide clear guidance on whether or not it is appropriate for them.
Examining the Data: A Comprehensive Survey of Aspirin Use
The study analyzed data from the National Health Interview Survey, encompassing nearly 150 million adults in the United States between 2012 and 2019, as well as data from 2021. The researchers aimed to understand trends in aspirin use among people over 40 years old and examined how many individuals were taking aspirin as a preventive measure against cardiovascular disease.
Participants were divided into groups based on age and cardiovascular disease status, which was determined through self-reported histories of stroke, heart attack, coronary artery disease, or angina.
The results showed that between 2018 and 2019, aspirin use among older adults declined, following the release of new evidence that led the American College of Cardiology (ACC) and the American Heart Association (AHA) to recommend against routine aspirin use for primary prevention in people over 60 without a history of cardiovascular disease.
However, despite this updated guidance, by 2021, nearly one in three individuals aged 60 or older without cardiovascular disease were still using aspirin. Alarmingly, nearly one in 20 were taking the medication without consulting a doctor.
Understanding the Risks: Why Aspirin May Be Harmful for Older Adults
For many, aspirin seems like a harmless, over-the-counter medication, especially in low doses. But experts warn that regular use of aspirin, particularly in older adults, can lead to significant health risks.
“The primary risk is for bleeding from the stomach or gastrointestinal tract,” says Dr. Blair Suter, a cardiologist at The Ohio State University Wexner Medical Center in Columbus.
Suter, who was not involved in the study, further explains that this risk is heightened in individuals over 70, those with bleeding disorders, and patients who are taking specific combinations of medications.
The dangers posed by bleeding are not to be taken lightly. Suter advises that anyone unsure about whether their current medications could increase their bleeding risk should have a conversation with their doctor or pharmacist.
Who Should Be Taking Aspirin for Heart Health?
While the risks of aspirin use for primary prevention (preventing a first heart attack or stroke) are now well-documented, aspirin remains a critical medication for individuals with established cardiovascular disease.
Aspirin is often prescribed to patients who have already experienced a heart attack, stroke, or undergone procedures like bypass surgery or the placement of cardiac stents. In these cases, aspirin serves as a form of secondary prevention, helping to reduce the likelihood of a second cardiovascular event.
According to Ashish Sarraju, MD, a cardiologist at Cleveland Clinic and senior author of the study, “Decades of evidence show that daily low-dose aspirin can reduce the risk of a second cardiovascular event, such as a heart attack or stroke, by about 25 percent.”
Aspirin works by preventing the formation of blood clots, which can block blood flow to the heart or brain and cause a heart attack or stroke. However, for those without cardiovascular disease, the balance of benefits and risks is not as clear-cut.
Dr. Gupta suggests that there may still be some cases where aspirin could be beneficial for younger adults (ages 40 to 59) with high cardiovascular risk factors and low bleeding risk.
Regardless of age or medical history, experts agree that anyone considering aspirin therapy for heart health should discuss their individual risk factors and health status with a doctor. As William Lawson, MD, director of preventive cardiology at Stony Brook Heart Institute, explains, “Guidelines about medication use are based on risk in a large population, but each individual’s health status is unique and will alter the benefit-to-risk ratio of aspirin therapy.”
Why Do So Many Older Adults Continue to Take Aspirin?
Given the updated guidelines and evidence showing the risks of daily aspirin use for primary prevention, why do so many older adults continue to take the medication?
One reason is the longstanding history of aspirin as a go-to preventive measure for heart health. For many years, aspirin was widely recommended to prevent cardiovascular disease, and it remains the first drug physicians reach for during an active heart attack, says Dr. Suter.
However, the more recent studies that question aspirin’s effectiveness in primary prevention are only five to ten years old, meaning that the older recommendations still hold considerable weight in the minds of both doctors and patients. Dr. Gupta also points to a general lack of awareness and hesitancy to change long-standing practices as contributing factors.
There are also medical explanations for why some older adults without cardiovascular disease may still be taking aspirin.
As. Dr. Gupta explains, “While guidelines recommend against starting preventive aspirin in older adults, there is uncertainty about the optimal age to discontinue preventive aspirin in those already taking it, as these two scenarios have different risk-benefit considerations. There may also be some cases where aspirin use for primary prevention is felt to be reasonable by their doctors due to high cardiovascular risk.”
What Should You Do If You Are Taking Aspirin?
If you are currently taking aspirin for heart health but don’t have a history of cardiovascular disease, it’s essential to consult with your doctor before making any changes to your medication regimen.
“No one should stop their daily aspirin without talking to their doctor,” cautions Dr. Gupta. Abruptly discontinuing aspirin therapy could lead to unintended consequences, especially for individuals who have been on the medication for a long time.
Dr. Gupta also advises that if you have not had a heart attack or stroke and are taking aspirin for preventive reasons, it’s important to have a conversation with your doctor, particularly if you started taking it without their recommendation.
A thorough discussion of your medical history, risk factors, and the potential benefits and risks of continuing aspirin therapy can help you make an informed decision about your heart health.
Conclusion: A Shift in Aspirin Guidelines
In summary, while aspirin has long been a cornerstone of preventive heart care, recent evidence suggests that for many older adults, the risks of taking aspirin may outweight the benefits.
The new guidelines emphasize the importance of individualized care and informed decision-making. By having open discussions with healthcare providers, patients can ensure that their approach to heart health is both safe and effective.
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