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Despite evolving guidelines and new evidence, a significant number of older adults in the United States continue to use aspirin for primary prevention of cardiovascular disease (CVD). Recent studies and surveys indicate that this widespread use persists, although the benefits of aspirin for primary prevention are increasingly being questioned.

Aspirin has been a cornerstone of heart attack and stroke prevention for decades. A study published in the journal American Journal of Preventive Cardiology highlights that according to the 2022 US Preventive Services Task Force (USPSTF) guidelines, only a modest portion of the US population is eligible to take aspirin.

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According to the study, “7.2 million adults between the ages of 40 and 59 qualify for primary prevention therapy with aspirin, which is about 10 percent of this age group.” However, due to the increased risk of bleeding, about 30 percent of these people would be excluded from treatment, leaving about 5 million adults eligible for treatment.

Guidelines for the use of aspirin have changed significantly. In 2019, the American College of Cardiology and the American Heart Association updated their recommendations to advise that aspirin should be used only rarely for primary prevention because there is no net benefit. These guidelines were influenced by clinical trials that showed that the risk of bleeding often outweighs the benefit of aspirin in preventing first-time cardiovascular events.

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Despite the updated guidelines, many older adults continue to take aspirin. A recent survey by the University of Michigan’s National Poll on Healthy Aging found that about one in four adults between the ages of 50 and 80 take aspirin at least three times a week. Interestingly, nearly 60 percent of these individuals have no history of heart disease, suggesting that many take aspirin without a clear medical indication.

The main problem with continued aspirin use is the increased risk of bleeding, particularly in the gastrointestinal tract and brain. The USPSTF now recommends that adults aged 60 and older should not start taking aspirin for primary prevention because the risks outweigh the benefits. This recommendation is based on evidence showing that while aspirin can reduce the risk of heart attacks and strokes, it significantly increases the risk of bleeding.

In contrast, taking aspirin for secondary prevention – to prevent further heart attacks or strokes in people who have already experienced such events – remains a standard recommendation.

The high prevalence of aspirin use among older adults underscores the need for better communication and education about the updated guidelines. As Dr. Geoffrey Barnes of Michigan Medicine explained, “As the guidelines change, it is important for anyone over 40 to talk to their doctor about their individual cardiovascular risk.”

This tailored approach ensures that aspirin is used appropriately, minimizing unnecessary risks and maximizing potential benefits.

Although aspirin remains a valuable tool in certain contexts, its role in primary prevention should be carefully considered in light of current evidence and guidelines.