Should I be using aspirin to prevent heart disease?

Dr. Thomas Bailey, MD
Apr 29, 2024
2 min read

For many years, aspirin was recommended by health care professionals to help prevent cardiovascular diseases (CVD) such as heart attack and stroke. However, research from the last few years has led to a change in that recommendation. Read on to find out if you should be using aspirin to prevent heart disease.

The initial push to use aspirin for primary prevention (stopping disease before it happens) dates back to a study from the 1980’s. In that study, there was an impressive 44% drop in heart attacks among male physicians aged 40-84 who took a daily aspirin. This was thought to be secondary to the blood thinning effect of aspirin. Over the next two decades patients were routinely recommended low dose aspirin (75-100 mg daily) to reduce their risk of developing cardiovascular disease.

However, in 2018, studies showed much less benefit to aspirin than previously thought. Heart attacks were found to be reduced by only 11%. More importantly, there were significant risks of stomach and brain bleeding identified in certain study groups. It is thought that other strategies to prevent heart disease, such as decline in smoking, better treatment of high blood pressure, and a focus on healthier living and eating have led to a decrease in aspirin’s effectiveness in primary prevention of heart disease.

Because of these findings and concern for bleeding in aspirin users, in 2022 the US Preventive Services Task Force (USPSTF) changed their recommendations for aspirin use. They recommend the following:

· For adults aged 40 to 59 years with an estimated 10% or greater 10-year CVD risk the decision to use low-dose aspirin use for the primary prevention of CVD should be an individual one.

· For adults 60 years or older, do not initiate aspirin for the primary prevention of CVD.

The American College of Cardiology and the American Heart Association have similar but slightly different recommendations. Their guidelines are as follows:

· Low-dose aspirin might be considered for the primary prevention of CVD among select adults 40 to 70 years of age who are at higher risk CVD risk but not at increased bleeding risk.

· Low-dose aspirin should not be administered on a routine basis for the primary prevention of CVD among adults over 70 years of age.

· Low-dose aspirin should not be administered for the primary prevention of CVD among adults of any age who are at increased risk of bleeding.

It is important to note that these guidelines do not apply if you have already experienced a CVD event, such as heart attack, bypass surgery, stent procedure or stroke. Most patients that have experienced these illnesses will likely need to be on aspirin lifelong as part of a treatment strategy called secondary prevention.

If you are not already taking a daily aspirin, talk to your doctor about these recommendations before deciding if aspirin is right for you. Even more important, if you are already taking low-dose aspirin you should not stop taking it until you discuss it with your physician.