Experts No Longer Recommend Aspirin Use to Prevent Heart Attack, Stroke for Most Patients


Proposed new guidelines recommended against low-dose aspirin use for primary prevention of CVD in adults age 60 years or older, citing adverse effects.

Previously, a daily low-dose aspirin regimen was recommended by clinicians for heart health, particularly in the prevention of heart disease and stroke, considered the leading cause of mortality in the US.

But due to mounting evidence on the adverse effects of aspirin use, a new draft recommendation statement from the US Preventive Services Task Force (USPSTF) reversed the 2016 recommendation statement on its use.

Now, the task force recommends clinicians should no longer prescribe low-dose aspirin use to most people at high risk of cardiovascular disease (CVD).

Who does this affect?

The new recommendations would apply to patients aged 40 to 59 years old, at high risk of CVD (≥10%) without a previous history of CVD. The USPSTF recommended patients consider the decision with their provider to begin taking aspirin, citing low net benefit for this patient group.

Additionally, they noted patients in this group not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit.

On the other hand, the statement highlighted that patients aged 60 or older should not begin an aspirin regimen for heart disease and stroke prevention.

“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” said Chien-Wen Tseng, MD, a member of the USPSTF. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”

What is the evidence?

Despite evidence backing daily aspirin use lowering the chance of first heart attack or stroke, there are harmful effects, including bleeding in the stomach, intestines, and brain. It is shown that the chance of bleeding is increased with age, which can be deadly.

Since the 2016 recommendation statement, evidence has determined the risk of bleeding outweighs the larger benefit of heart disease prevention.

Research has shown that the risk-benefit profile of aspirin is a closer balance for patients in their 50s, while starting aspirin use in patients who are 40 years old may have greater benefit.

It is noted that the recommendation is applied to those at higher risk for CVD, with no history of CVD, and are not currently taking daily aspirin. The statement recommended clinicians consider age, heart disease risk and bleeding risk, as well as a patient’s values and preference, in determining whether to begin an aspirin regimen.

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” said John Wong, MD, a member of the USPSTF. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”

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