Taking an aspirin a day isn’t as good as you think

Many older people who take aspirin daily do not suffer from cardiovascular disease, meaning they have little benefit from it

One in four older adults takes aspirin at least three times a week, primarily in the hopes of preventing heart attacks and strokes, according to a new survey.

However, many of the people ages 50 to 80 who reported taking aspirin may not need it, results from the University of Michigan’s National Survey on Healthy Aging show.

Overall, 57% of people ages 50 to 80 who reported taking aspirin regularly also said they had no history of cardiovascular disease. These people should talk to their doctor about what is best for them before stopping or starting taking aspirin.

National guidelines for preventive use of aspirin have changed in recent years as new insights have emerged about who really benefits most from its ability to reduce the risk of blood clots and who is at risk of bleeding.

The guidelines now focus primarily on the use of aspirin in people who already have cardiovascular disease – including those who have survived a heart attack or stroke – and in people who, due to their health and family history, have a high risk of cardiovascular disease There is a risk of cardiovascular disease.

Aspirin with or without cardiovascular disease

According to the survey, 14% of adults ages 50 to 80 take aspirin, even if they have no history of cardiovascular disease.

With or without a history of cardiovascular disease, aspirin poses a bleeding risk that increases with age. This has led to guidelines recommending against routine use of aspirin after age 70 or suggesting that it may be prudent to stop taking aspirin around age 75 in people without cardiovascular disease.

The survey shows that 42% of adults aged 75 to 80 take aspirin. Meanwhile, 31% of older adults ages 50 to 80 who take aspirin appear to be unaware of the associated bleeding risk. The survey team asked a national sample of adults ages 50 to 80 about their medical history and aspirin use; Those who took it were also asked why.

“Aspirin is no longer a unique preventative for older adults as it has been touted for decades,” says Dr. Jordan Schaefer, a hematologist at Michigan Medicine who worked with the survey team. “This survey shows that we still have a long way to go to ensure that aspirin use is consistent with current knowledge.”

Geoffrey Barnes, MD, M.Sc., a cardiologist at Michigan Medicine who also worked on the survey, adds: “As guidelines change, it is important for everyone over 40 to talk to their doctor about their individual cardiovascular risk regarding your family.” Medical history, previous health problems, current medications, current test results such as blood pressure, cholesterol and blood sugar, and lifestyle factors such as smoking, physical activity and eating habits. “Preventative use of aspirin should be based on age and these factors.”

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Updated advice on aspirin

Overall, the survey finds that 71% of older adults who take aspirin started four or more years ago, which could mean they and their healthcare provider are basing their use on old advice.

Schaefer and Barnes point out that because of continued research on aspirin in recent years, two important guidelines have changed for older adults without cardiovascular disease. For these people, taking aspirin is referred to as primary prevention.

The American College of Cardiology and the American Heart Association jointly say that daily use of low-dose aspirin could be considered to prevent cardiovascular disease in select adults ages 40 to 70 who are at increased risk for cardiovascular disease but not for bleeding, according to a guideline updated in 2019. The U.S. Preventive Services Task Force, which advises the federal government, updated its guidance in 2022 to recommend not starting aspirin use to prevent cardiovascular disease in adults age 60 and older.

The AHA and ACC offer online calculators to help doctors estimate a person’s 10-year risk of cardiovascular disease if they don’t already have it. Adults ages 40 to 70 who are at higher risk of cardiovascular disease may be good candidates for taking aspirin for primary prevention, but they should always speak to a doctor before starting use.

For people who have already suffered a heart attack, certain strokes or other cardiovascular diseases, taking acetylsalicylic acid is generally still recommended unless the person cannot tolerate it or there is an unreasonable risk of bleeding. This is called secondary prevention and should only be done under the supervision of a healthcare professional.

More dialogue is needed

The survey highlights the importance of open communication between healthcare professionals and their elderly patients about all types of medications and supplements, including those such as aspirin, which can be purchased “over the counter.”

The survey shows that 96% of those who take aspirin and have cardiovascular disease say their doctor recommended it to them. But 77% of those who take aspirin and have no history of cardiovascular disease said the same, suggesting a debate about updated guidelines is needed. Even among those who take aspirin but do not have cardiovascular disease, 20% said they started taking it themselves and 5% said friends and family advised them to do so.

“With updated knowledge and reduction of other important risk factors such as smoking, we can use aspirin more precisely, focus on those who most need this cheap and readily available preventive drug, and avoid unnecessary risks to others,” said the survey leader. Dr. Jeffrey Kullgren. “These survey results should encourage more conversations between healthcare professionals and patients about what is right for them.”

Source: University of Michigan

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