The Daily Aspirin: To take or not to take?
Kitty Finklea, RDN, LDN, AFAA-CPT
Many people over age 50 have been taking daily low-dose aspirin for years to help prevent a heart attack or stroke. Aspirin acts as a blood thinner to keep blood from clumping together. In a narrowed artery in the heart or brain, there is a higher chance of clotting, and a clot can block blood flow and lead to a heart attack or stroke.
Since it is an over-the-counter medication, people often consider aspirin safe, but like most medications, it is not without side effects. Aspirin is irritating to the stomach lining and can cause stomach upset, bleeding, and ulcers. And since it thins the blood, aspirin can be dangerous for those at higher risk of bleeding. Aspirin should not be taken by people with a history of bleeding or clotting disorders, gastritis, ulcers, or other stomach problems, as well as people with severe kidney or liver disease or who are already on blood thinners.
In October 2021, the media were full of reports from the U.S. Preventative Services Task Force recommendation regarding daily low-dose aspirin use. It caused quite a bit of confusion on whether daily aspirin was helpful or risky for prevention of heart-related events in people with no evidence of heart disease. But many people began to worry about starting or continuing a daily low-dose aspirin regimen.
The task force was created in 1984 and is an independent, volunteer panel of national experts in prevention and evidence-based medicine. This panel is tasked with reviewing volumes of current peer-reviewed evidence to make recommendations to help primary care providers and patients make an informed decision on preventative treatment or services. The task force gives each recommendation an A, B, C, D grade or an I for inconclusive evidence, and all information is posted on its website.
In 2016, the task force was already pulling back on daily aspirin unless there is an elevated risk of cardiovascular disease in people ages 50-69 with a 10 percent or greater chance of heart attack or stroke in the next 10 years. Since 2016, studies indicated that for people with a history of cardiovascular disease, aspirin did not prevent subsequent heart attacks or strokes over a period of five years and increased the risk of stomach bleeding, especially in women.
The current recommendation from the task force issued in October 2021 recommended for people ages 40-59 with a higher risk of cardiovascular disease that the decision to initiate aspirin therapy should reflect “professional judgment and patient preferences,” with a “C” grade indicating the benefit is small. And for people age 60 and over, the task force does not recommend initiating aspirin for cardiovascular disease prevention. The new guidelines are only for those who do NOT have established heart disease. Aspirin is still recommended as a therapy to help prevent recurrent heart attacks and strokes for those who have known cardiovascular disease.
The bottom line? Everyone is different. Talk to your primary care provider with questions about starting or continuing a daily aspirin regimen.