Guidance is Changing on Low-Dose Aspirin To Prevent Heart Disease

Many adults have been advised by their doctors to take low-dose aspirin to prevent heart disease. But the guidance is changing, as newer research shows the benefits of daily aspirin do not outweigh the risks for some patients. If you’re taking aspirin for prevention, you may want to talk with your doctor.

Aspirin helps prevent clots from forming in the blood vessels, which can cause heart attack or stroke. However, the new recommendations are based on research showing the risks of stomach bleeding in older adults outweigh the blood-thinning benefits of daily aspirin.

Tiered Approach

The new draft recommendations, issued by the U.S. Preventive Services Task Force in October, say people 60 and older with no history of heart attack or stroke should not take a daily dose of aspirin for prevention.

“No longer do we have a blanket recommendation of aspirin for prevention for all people of all ages,” says UH cardiologist Ian Neeland, MD. “The benefit of low-dose aspirin for primary prevention of heart disease may not outweigh the potential risk of bleeding, and becomes especially important for individuals who are older, where risk of bleeding is increased.”

The recommendation against aspirin for people 60 and older applies to those who have never had a cardiovascular event such as heart attack, stroke or coronary stent. People with a history of cardiovascular disease may continue low-dose aspirin based on guidelines and their doctor’s recommendation, Dr. Neeland says.

Younger patients at risk for heart disease who have low risk of bleeding may still benefit from daily aspirin, even if they have no history of a cardiovascular event.

Underlying Health Problems

Advancing age and underlying health problems increase risk of bleeding. Dr. Neeland says primary care doctors may want older patients with health problems to stop taking aspirin, especially if their other risks factors are under control.

“Aspirin increases risk for stomach bleeding. That can be minor, where people can be bleeding long-term and they don’t realize they’re having blood loss in their stool. They may become anemic,” Dr. Neeland says.

“When someone is anemic, they may feel fatigued or short of breath. Severe anemia can cause more serious problems, even heart failure,” he says. “A large bleed, where blood comes out in the stool or you throw up blood, can be dangerous and potentially fatal.”

The new guidelines specifically address preventive aspirin for patients with Type 2 diabetes. Because these patients are at elevated risk for heart disease, doctors have routinely recommended aspirin.

Dr. Neeland says a blanket approach is no longer recommended, and diabetes patients should be evaluated like all patients, case by case, based on age and other factors.

The task force guidelines are open for comments from the public and health experts until Nov. 8, 2021. The comments will then be reviewed by members of the task force and the guidelines will be finalized.

Related Links

UH Harrington Heart & Vascular Institute offers more options for cardiovascular care close to home with multiple locations across Northern Ohio. Ongoing investments in our local facilities ensure our team has the latest tools and therapies available to continue to deliver truly personalized care for patients where and when they need it most. Learn more about cardiovascular care at UH Harrington Heart & Vascular Institute.