New research suggests that as many as 18.5 million older adults regularly take aspirin to prevent the onset of cardiovascular disease, even though the drug’s risks outweigh its benefits for many of those patients.
The new study, published Monday in the journal Annals of Internal Medicine, examined self-reported data from more than 186,000 adults across the United States and found that nearly one-third of those age 60 or older without cardiovascular disease were using aspirin in 2021. The drug is generally not recommended for those patients, in large part because it increases the risk of gastrointestinal bleeding.
“Some of this use is potentially harmful, because it may cause more bleeding than it offers cardiovascular protection, in these older adults especially,” said Dr. Mohak Gupta, an author of the study and a senior resident physician at Cleveland Clinic.
Dr. Valentin Fuster, the president of the Mount Sinai Fuster Heart Hospital and former president of the American Heart Association, said he was concerned that so many patients who won’t benefit from aspirin were still taking it, and that in many cases, doctors seem to have advised these patients to use the drug.
“It’s not actually the patients that get in their own way,” said Dr. Fuster, who was not involved in the study. (The study did find, however, that doctors recommended the drug less often in 2021 than they had in previous years.)
Who should take a daily aspirin?
Aspirin works by thinning the blood, which lowers the risk of blood clots that can clog arteries and lead to a heart attack or stroke. For many years, doctors recommended taking a low dose of aspirin to prevent heart disease.
But that practice started to shift in recent years. In 2019, the American Heart Association and the American College of Cardiology released guidance that suggested the blood thinners should not be routinely used to prevent cardiovascular issues in adults over 70. And in 2022, the U.S. Preventive Services Task Force recommended against people 60 or older without a history of cardiovascular problems using aspirin to prevent heart disease.
Doctors have warned against using it in these patients because of the risk of gastrointestinal bleeding, which Dr. Gupta said is highest in those who are 60 and older or who are already at risk of gastrointestinal bleeding.
Certain groups of patients may still benefit from a daily aspirin, including those who have previously suffered from a heart attack, a stroke or have been diagnosed with heart disease, Dr. Gupta said. In these cases, the drug may prevent heart problems from recurring or worsening, he added.
The drug might also be appropriate for people ages 40 to 59 who don’t have a history of bleeding but who are at a higher risk of cardiovascular disease because of obesity, high blood pressure, high cholesterol, smoking or other risk factors, Dr. Gupta said.
Even though aspirin is available over the counter, its risks mean that patients should always consult their doctor before using the medication, Dr. Gupta said. “This is a decision that should not be made by patients themselves,” he said.