Aspirin can be a lifesaver if you’re having a heart attack. But aspirin for the prevention of heart disease is another story. Recommendations for aspirin as a long-term remedy to lower the risk of cardiovascular disease (CVD) have recently been modified.
The use of low-dose aspirin to reduce the risk of heart attack and stroke has changed as more evidence from large clinical studies becomes available. The latest recommendations from the United States Preventive Services Task Force (USPSTF) replace their guidelines from 2016. The new recommendations are published in the September 2022 Annals of Internal Medicine.
The discovered benefits of low-dose aspirin for prevention of CVD are based on a review of 13 clinical trials involving over 160,000 people. The USPSTF weighed these benefits against the risk of possible harm from aspirin in 14 clinical trials.
Risk Factors Determine Aspirin Intake
The key recommendations are to start low-dose aspirin for people between the ages of 40 to 59 who have a 10 percent or greater risk of heart disease or stroke within 10 years. For these people, studies show a small net benefit. This decision should be individualized, meaning it should be reached between a person and her or his doctor based on a discussion of the individual’s risks and benefits.
Other key recommendations include:
- People who are at an increased risk for bleeding should not use low-dose aspirin. Bleeding risks include a history of gastric ulcers, any recent bleeding and any medical conditions or medications that increase the risk of bleeding. Aspirin may increase the risk of gastrointestinal bleeding and a stroke caused by bleeding in the brain (hemorrhagic stroke), and these risks increase with age.
- People over age 60 should not use low-dose aspirin for CVD prevention. Studies show there is no net benefit after age 60.
- Ten-year CVD risk should be based on the American College of Cardiology/American Heart Association risk estimator. This estimator includes consideration of a person’s age, sex, race, cholesterol level, blood pressure, diabetes history and smoking history.
- People with a 10-year risk greater than 10 percent are more likely to benefit from low-dose aspirin.
- The lowest effective dose of aspirin should be used, which is 81 milligrams per day.
- The risk of low-dose aspirin starts to outweigh the benefits in older age, so use of low-dose aspirin should be stopped around age 75.
The Older You Are, the Less Benefit from Aspirin
The age recommendations have changed from what the USPSTF advised in 2016. In 2016, low-dose aspirin for CVD prevention was recommended for adults aged 50 to 69 with a greater than 10 percent 10-year risk, no increased risk for bleeding, and a life expectancy of at least 10 years. For people ages 60 to 69, low-dose aspirin was recommended on an individual basis. At that time, there was insufficient evidence on risk versus benefit for people under age 50.
CVD is the leading cause of death for Americans, causing one in four deaths from heart attack or stroke. Other recommendations for reducing CVD risk from USPSTF include statin use for lowering cholesterol, smoking cessation, heathy diet, physical activity, and screening for high blood pressure and diabetes.