Daily aspirin use among older adults remains prevalent despite potential risks

A recent survey shows that one-third of adults ages 60 and older without heart disease take aspirin, some without medical advice.

• Aspirin is a common over-the-counter medication that can help relieve pain and reduce the risk of blood clots.
• Past recommendations have included taking aspirin to help prevent cardiovascular disease.
• Recent guidance indicates that adults over 70 should not use aspirin for primary prevention of heart disease.
• A recent survey found the number of adults using aspirin to prevent heart disease has decreased, but around one-third of adults ages 60 and older without heart disease were still taking aspirin, some without medical advice.

Aspirin is a well-known medication available in many forms, both over-the-counter and prescription.

People often use nonprescription aspirin for pain relief and fever reduction. Aspirin is also helpful in preventing the formation of blood clots.

Daily aspirin was previously recommended as a primary prevention method to help prevent cardiovascular disease in older adults, but these guidelines have shifted.

A recent study published in the Annals of Internal Medicine reviewed the prevalence of aspirin use among adults in the United States to prevent cardiovascular disease.

Researchers found that despite changes to clinical guidelines, 29.7% of adults age 60 and older were taking aspirin for primary prevention of cardiovascular disease from 2012 to 2021, and 5.2% were doing so without medical advice from health professionals.

The results highlight the importance of doctors communicating with people about aspirin use.

Is daily aspirin no longer recommended?

Daily aspirin is no longer advised as a primary prevention method for cardiovascular disease (CVD), but some people may benefit from taking aspirin as a secondary prevention method.

Primary prevention involves healthy individuals susceptible to a particular disease taking action to decrease their chances of getting it. In contrast, secondary prevention focuses on interventions for people who have a history of a particular condition, such as a stroke or heart attack.

As noted by the current study, the American Heart Association and the American College of Cardiology updated their guidelines about using aspirin as a primary prevention for CVD.

Based on these recommendations, adults older than 70 should typically not use aspirin as a method of primary prevention for CVD. In contrast, doctors have recommended using aspirin for primary prevention of CVD in the past.

However, doctors may recommend a daily low dose of aspirin for people who have already had a heart attack or stroke to prevent these from happening again as part of national guidelines.

Non-study author Rigved Tadwalkar, MD, a board certified consultative cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, offered further insight into current recommendations to Medical News Today:

“Generally, for primary prevention in older adults without a history of cardiovascular disease, current guidelines from the American College of Cardiology and the American Heart Association advise against the routine use of aspirin. However, low-dose aspirin (75-100 mg) might be considered for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among select adults 40-70 years of age who are deemed to be at higher risk of ASCVD but not at increased risk of bleeding. Risk factors considered in this assessment include tobacco history, blood pressure, cholesterol levels, and family history. This is a class IIb recommendation with level A evidence, meaning its usefulness and efficacy are less established but reasonable based on high-quality research.”

Trends in aspirin use among U.S. adults

As noted by the current study, in 2019, there was a change in guidelines for aspirin use based on randomized trial data showing outcomes and risks of long-term aspirin use. However, there has not been much research on how these commendations have influenced clinical practice in the U.S.

Researchers from this study included 186, 425 participants, representing 150 million adults in the U.S. The data was from the National Health Interview Survey Sample Adult component. This is a health survey where the sample represented the U.S. civilian non-institutionalized population.

Researchers included data from adults ages 40 and older in their analysis. They looked at the participant-reported history of stroke, heart attack, angina, and coronary artery disease. Researchers were also able to identify people who reported taking low dose aspirin for heart disease prevention, either as self-users or as doing so under medical advice.

The study’s results found that the use of aspirin for primary prevention had a minimal decline from 2012 to 2017, with greater decreases after 2018. By 2021, there was also a decrease in medically advised aspirin use for primary prevention.

However, in 2021, about 18.5% of adults 40 and older reported use of aspirin for primary prevention. Among adults 60 and older, 29.7% used aspirin for primary prevention, and 5.2% used aspirin without medical advice.

Overall, the results suggest that more physicians are encouraging people to stop taking aspirin to prevent CVD. However, the results also suggest that about 3.3 million adults age 60 and older are still taking aspirin for primary prevention without medical advice.

Tadwalkar noted the following about the findings of the study:

“The survey findings are concerning. While recent guidelines advise against routine aspirin use for primary CVD prevention in many older adults, a significant number continue to take it. This highlights a gap in communication between doctors and patients regarding the individualized approach to aspirin therapy.”

Dr. Kevin Rabii, a cardiologist with Memorial Hermann, commented with his thoughts on the findings of the research to MNT:

“The role of aspirin for primary prevention of cardiovascular disease has become much more limited in recent years. Newer studies failed to show the cardiovascular benefits of taking aspirin preventively. The keyword here is ‘preventively.’ It is important to understand that this does not apply to those with established disease, such as those with prior heart attacks, stents, or bypass surgery. Updated recommendations from various groups reflect this new information. This particular study showed that despite these newer recommendations, many individuals still take aspirin for primary prevention.”

Should you take daily aspirin?

This study has some limitations, primarily that it relied on self-reporting from participants, which increases the risk of recall bias. Researchers were also limited by lacking the data required to estimate bleeding risk and CVD.

While the sample was representative of most of the U.S. population, this doesn’t necessarily mean that the data can be generalized to other groups. The research also did not include data from adults under 40 or data from the survey years 2020 and 2022.

Still, the research highlights an important component: People must communicate with their doctors to determine whether taking aspirin is appropriate.

Tadwalkar noted the following:

“The key point is that daily aspirin for heart health is no longer a straight forward decision. It is definitely recommended for most who have already had a cardiovascular event like a heart attack. However, for people without that history, it gets more nuanced. Some high-risk individuals might benefit, but there’s also a competing risk of bleeding. Certainly, daily aspirin is no longer recommended for people who have no history of heart disease and are deemed low risk, and for those with a high risk of bleeding, such as from stomach ulcers. The takeaway is to talk to your cardiologist. They can assess your specific situation, including risk factors for heart disease and bleeding, to see if daily aspirin is the right choice for you.”

https://www.medicalnewstoday.com/articles/daily-aspirin-use-remains-high-among-older-adults