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Daily aspirin no longer recommended for some

Poonam Chhibber, MD, explains the recent changes

Man taking medicine

Low-dose aspirin (81 to 100 milligrams, aka baby aspirin) has long been recommended as a safe and inexpensive way to reduce the risk of cardiovascular disease (CVD), heart attacks, strokes and blood clots. In October, the U.S. Preventive Services Task Force changed these long-held recommendations, raising many questions for patients. Here’s what you need to know.

What has changed

People aged 60 and older who do not have cardiovascular disease are now strongly discouraged from starting daily aspirin therapy to prevent a first heart attack or stroke.

Why did the aspirin recommendations change?

New research found that the risks of daily aspirin begin to outweigh the benefits starting at age 60. Specifically, the risk of aspirin causing potentially life-threatening bleeding in the brain or gastrointestinal tract increases with age. A review of the literature found that the incidence of these bleeding complications outnumbered preventive effects for people over 60 without established CVD.

What has not changed

Aspirin still has clear benefits for many people who already have cardiovascular disease or who are at high risk for it. These include:

  • People with acute coronary artery syndrome 
  • People with acute occlusive stroke
  • People with stable ischemic heart disease, carotid artery disease or peripheral artery disease
If you’re already taking aspirin, should you stop?

Not necessarily — aspirin is still very beneficial for many people. Please talk to your provider before you stop. If you’ve had a previous heart attack or stroke and you’re on aspirin to prevent another one, for example, it’s important to keep taking it until your provider advises you otherwise.

The new recommendations are aimed at people who have not yet started preventive aspirin therapy. If you currently take aspirin, have a conversation with your provider about whether continuing the therapy is right for you.

If you’re younger than 60, is it OK to start aspirin?

If you’re 40-59 and you’re at higher risk for CVD, you might benefit from daily aspirin — but talk to your provider about it first to make sure it makes sense for your individual situation.

The takeaway

Preventive aspirin use is not a blanket approach anymore — your individual risks and benefits need to be assessed within the context of your whole health picture to decide whether aspirin is right for you. Please consult your provider before starting daily aspirin or making any changes in your current aspirin therapy.