Experts are cautioning that taking daily aspirin – long a standard practice – is not recommended for people who have no history of cardiovascular disease (CVD) or stroke. And in older adults with no risk of heart attack, aspirin could actually cause more harm than good.
"One size does not fit all when it comes to using aspirin for cardiovascular disease (CVD) prevention. The decision to initiate low-dose aspirin for the primary prevention of CVD should be an individual one," said Geetanjali Dang, MD, a cardiologist with Baptist Heart Specialist.
Low-dose aspirin recommendations revised
Despite being a common practice for decades, prescribing a daily dose of so-called "baby aspirin" is no longer recommended by the American Heart Association (AHA) or the American College of Cardiology (ACC). The two organizations in 2019 released revised low-dose aspirin guidelines after clinical trials showed the benefits don't always outweigh the risks, which include an increase in internal bleeding, particularly in the gastrointestinal tract.
In addition, in 2022, the U.S. Preventive Service Task Force (USPSTF) released new recommendations that generally align with that guidance, advising that people over 60 shouldn't start taking daily low-dose aspirin to prevent cardiovascular events like heart attacks or strokes. For adults 40 to 59 with 10% or greater 10-year cardiovascular disease risk, a daily aspirin may have a "small net benefit," according to the task force.
However, low-dose aspirin continues to be recommended for those who have existing heart problems, including a history of a heart attack or stroke.
New guidelines and expert recommendations
A daily dose of 75 to 100-milligram aspirin is not recommended for adults older than 60 (USPSFT) or 70 (AHA/ACC) for the primary prevention of coronary artery disease, heart attack or stroke if they have no known cardiovascular risk. Aspirin is potentially harmful given the higher risk of bleeding in this age group.
Adults of any age who are at increased risk of bleeding should not be given a low-dose aspirin for the primary prevention of cardiovascular disease.
People who have had a stroke, heart attack, cardiovascular disease or peripheral vascular disease (a blood circulation disorder) should continue taking low-dose aspirin as recommended by their health care provider. Aspirin is known to reduce the formation of blood clots or blockages in blood vessels.
If you have been taking daily aspirin and you don't have heart disease, talk to your primary care doctor about whether you should stop.
Alternative ways to reduce your risk of heart disease
Those who are not at high risk can protect themselves from a stroke or heart attack through healthy eating habits, exercise and avoiding tobacco, said Dr. Dang.
Engaging in regular physical activity and adhering to a healthy diet high in fruits, vegetables and whole grains is key. Fish, legumes and poultry are the preferred sources of protein. Minimizing the consumption of trans fats, added sugars (including sugar-sweetened beverages), red meats, sodium and saturated fats is also essential.
Learn your risk and get checked regularly
The best way to prevent a heart attack is to know your risk factors and get regular check-ups with your primary care physician. If you're concerned about your heart health, visit baptistjax.com/heart to find a cardiologist near you.