Aspirin therapy


Too Many Older Adults Still Taking Aspirin for Heart Health, Even Though Most Shouldn’t Be, New Study Finds

Baptist Health Miami Cardiac & Vascular Institute

About one-third of U.S. adults over the age of 60 continue to take a daily aspirin to prevent cardiovascular disease, even though this practice is only recommended for certain high-risk patients, according to a new study which reiterates the significant risk of taking a daily aspirin without consulting your doctor.

In 2019, both the American College of Cardiology (ACC ) and the American Heart Association (AHA ) updated its guidelines to urge adults not to use aspirin as way to prevent heart disease because of the risk of bleeding -- unless prescribed by a doctor.

In 2022, a prominent U.S. panel of experts -- the U.S. Preventive Services Task Force – also updated its guidance, stressing that “people age 60 or older should not start taking aspirin for heart disease and stroke prevention.” The Task Force guidance does not apply to people already taking aspirin for a previous heart attack or stroke.

Jonathan Fialkow, M.D., Chief Population Health Officer for Baptist Health and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute.

“We don’t want to give aspirin, with the bleeding risk, if the cardiovascular event risk is relatively low,” explains Jonathan Fialkow, M.D., chief medical executive of Population Health, Value and Primary Care for Baptist Health, and deputy director of Clinical Cardiology at Baptist Health Miami Cardiac & Vascular Institute. "There are several medical organizations that create guidelines, and not all are exactly the same. But the general consensus is: If you do not have established cardiovascular disease , the bleeding risk of aspirin in adults over 60 years-old outweighs the cardiovascular protection -- and it is NOT recommended. Some say 70 years-old. But either way, the indication for pure prevention when someone has never had a cardiovascular event, or is not at high risk, has been debunked."

The updated recommendations focus on low-dose aspirin therapy that previously was prescribed for older adults who did not carry a high risk for heart attack or stroke — or any adult at an increased risk of bleeding. In 2018, studies began emerging that found a daily low-dose aspirin — 100 milligrams or less — was of no benefit for older adults who do not have heart disease.

“In adults with cardiovascular disease -- or previous heart attack or ischemic stroke, or coronary bypass surgery -- taking a daily aspirin would be considered appropriate to take if tolerated, and there are no contraindications,” adds Dr. Fialkow. “There is some thought that it can be stopped after the age of 75, even if one has cardiovascular disease. But that recommendation is not well-established yet.”

The new study, published in Annals of Internal Medicine, focused on data on more than 180,000 people from the U.S. Centers for Disease Control and Prevention’s National Health Interview Survey (2012–2019 and 2021). The data looked at the prevalence of aspirin use for prevention of cardiovascular disease. Participants aged 40 years or older were asked to report aspirin use and were classified by age group and heart-health status based on self-reported history of stroke, heart attack, coronary artery disease, or angina.

Researchers found that about 19 percent of surveyed adults, aged 40 or older, reported taking aspirin for the primary prevention of the disease. Among adults 60 to 69 years of age, about 27 percent reported taking aspirin to prevent cardiovascular disease, and that figure jumped to 38 percent among adults 70 years of age or older. Moreover, about 5 percent of all adults 60 or older reported using aspirin without medical advice.

“Generally, the point is that people should not take aspirin for prevention,” said Dr. Fialkow. “But if you have cardiovascular disease, you should take it to prevent further cardiovascular events. People who should not take daily aspirin, to name a few, are people without cardiovascular disease; people with bleeding disorders or illnesses that increase risk of bleeding; people who have gastritis or gastric ulcers; people who are allergic to aspirin; people who may tend to fall frequently.”

Patients with diabetes who have one additional cardiac risk factor, such as hypertension or hyperlipidemia, would be considered a candidate for aspirin therapy for prevention even before age 70, adds Dr. Fialkow.

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With internationally renowned centers of excellence, 12 hospitals, more than 27,000 employees, 4,000 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve.

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