As many as 18.5 million older adults regularly take aspirin to prevent the onset of cardiovascular disease, but for many patients the drug’s risks outweigh the benefits, according to a new study.
new studyA study published Monday in the medical journal Annals of Internal Medicine looked at self-reported data from more than 186,000 adults across the United States and found that about one-third of people over 60 without cardiovascular disease used aspirin in 2021. The drug is not typically recommended for these patients, mainly because it increases the risk of gastrointestinal bleeding.
“Some of these uses are potentially harmful, especially in older adults, because they may cause more bleeding than cardiovascular protection,” said study author Mohak Gupta, M.D., a senior resident at the Cleveland Clinic.
Dr. Valentin Fuster, president of Mount Sinai Fuster Heart Hospital and past president of the American Heart Association, expressed concern that many patients who would not benefit from aspirin are still taking it and that in many cases, doctors appear to be recommending aspirin use for these patients.
“It’s not really the patients that are getting in the way,” said Dr. Fuster, who was not involved in the study (which did find, however, that doctors recommended the drug less frequently in 2021 than they did the previous year).
Who should take an aspirin every day?
Aspirin thins the blood, lowering the risk of blood clots that can clog arteries and lead to heart attacks and strokes. For many years, doctors have recommended taking low-dose aspirin to help prevent heart disease.
But in recent years, that practice has begun to change. In 2019, American Heart Association The American College of Cardiology issued guidance that blood thinners should not be used routinely to prevent cardiovascular disease in adults over 70. And in 2022, U.S. Preventive Services Task Force People over 60 with no history of cardiovascular disease are advised not to take aspirin to prevent heart disease.
Doctors are warning these patients not to use the drug because of the risk of gastrointestinal bleeding, which Dr. Gupta said is highest in people over 60 and those who are already at risk for gastrointestinal bleeding.
Dr. Gupta said certain patient groups may still benefit from taking a daily aspirin, such as those who have previously had a heart attack or stroke or have been diagnosed with heart disease. In those cases, the drug may prevent heart problems from recurring or getting worse, he added.
Dr Gupta said the drug may also be appropriate for people aged 40 to 59 who have no history of bleeding but are at high risk of cardiovascular disease because of obesity, high blood pressure, high cholesterol, smoking or other risk factors.
Aspirin is available over the counter, but given its risks, patients should always talk to their doctor before using it, Dr. Gupta said. “This is not a decision that should be made by the patient,” he said.