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Previously, doctors would suggest that individuals at risk of heart attack take a low-dose aspirin as a preventative measure. However, this approach has grown less common, with the US Preventive Services Task Force indicating that aspirin may now pose more harm than good in many cases.
If you are currently taking low-dose aspirin to prevent heart attacks, do not stop based on this recommendation alone. Consult your doctor first. The new guidelines—still not finalized—suggest that doctors should not start anyone over the age of 60 on low-dose aspirin as a preventative measure. For individuals aged 40-59, whether or not to begin aspirin should be decided on a case-by-case basis by the doctor.
What led to this change in recommendations?
The draft recommendation provided by the USPSTF is available for review. You can check their suggested guidelines and the reasoning behind them. This draft is still in the early stages, as it must undergo a public comment period before it can be finalized.
The previous guidelines from 2016 recommended that individuals aged 50-59 begin low-dose aspirin for the prevention of cardiovascular disease and colorectal cancer, as long as certain criteria were met. For individuals aged 60-69, it was to be considered on a case-by-case basis, and for those outside of these age ranges, the evidence was insufficient to make a recommendation either way.
What caused the change in these recommendations?
Every medication carries both risks and benefits. The main advantage of aspirin is its ability to help prevent blood clots, which are common in heart attacks, since aspirin acts as a blood thinner. However, the downside is that this thinning of the blood can increase the risk of bleeding, which could occur in the stomach or brain.
As the president of the American Heart Association mentioned to the New York Times, our understanding of bleeding risks has evolved over time, shifting how we evaluate the risk-benefit balance. Additionally, the benefits of aspirin have changed: when it was first recommended in the late 1980s, fewer effective methods existed to reduce heart disease risk.
The new recommendation might not feel like a drastic change. While the USPSTF is updating their guidelines now, healthcare providers have been moving in this direction for some time. For instance, the American Heart Association mentions on a patient website that “[b]ecause of the risk of bleeding, aspirin therapy is not recommended if you have never had a heart attack or stroke, except for certain carefully selected patients.”
The key takeaway remains the same: Discuss with your doctor whether taking aspirin for prevention is right for you. Don’t start it on your own, and don’t stop it without consulting your doctor. Just know that your doctor might be more cautious about recommending aspirin now than they were a few years ago.
(By the way: low-dose aspirin used to be marketed as “baby aspirin.” However, times have changed, and aspirin should never be given to babies due to the risk of Reye’s syndrome. This warning was issued in the early 1980s, and by the end of the decade, St. Joseph’s—once known for baby aspirin—had shifted its focus to promoting aspirin for heart disease prevention.)
