U.S. Panel Sets Guidelines on Restricting or Stopping Daily Aspirin Use to Prevent First Heart Attack, Stroke

A U.S. panel of experts has finalized its guidance regarding restrictions of daily aspirin intake to lower the risk of a first heart attack or stroke. People, ages 40 to 59, who are at higher risk for cardiovascular disease (CVD) — and do not have a history of CVD — “should decide with their healthcare professional whether to start taking aspirin to prevent a first heart attack or stroke,” according to the final guidelines by the U.S. Preventive Services Task Force.

In its guidance, the task force also stresses that “people age 60 or older should not start taking aspirin for heart disease and stroke prevention.” The new draft recommendation does not apply to people already taking aspirin for a previous heart attack or stroke. They should continue to do so, unless otherwise instructed by their physician, the task force emphasizes.

“The big takeaway from the new guidelines is that no one should be taking daily aspirin simply because they heard or read that it helps prevent a heart attack or stroke until you have consulted with your doctor,” explains Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute. “The decision should be made jointly when considering your risk of cardiovascular disease and in combination of safe preventive measures or medications.”

The side effects from a daily regimen of aspirin outweigh any benefit, the task force said.

“Based on current evidence, the Task Force recommends against people 60 and older starting to take aspirin to prevent a first heart attack or stroke,” says Michael Barry, M.D., vice chair of the task force, in a news release. “Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group.”

Previous studies have found that millions of U.S. adults 40 and older are taking an aspirin a day, even though they were not diagnosed with heart disease. In 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) updated its guidelines by urging adults to avoid using aspirin as way to prevent heart disease because of the risk of bleeding, unless prescribed by a doctor.

The new 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.