Should You Take a Daily Aspirin? New Guidelines Released
Daily Aspirin No Longer Recommended for Heart Health in Some Older Adults
For decades, people have taken a daily aspirin to prevent heart attack and stroke. However, according to new research, taking a low-dose aspirin every day does not prolong the lives of healthy, older adults. A new clinic trial, called ASPREE, also found taking a daily aspirin increases rates of major hemorrhage, or bleeding, in adults who are 70 years old and older.
To help you understand the new guidelines, including who should take a low-dose aspirin and its potential risks, we sat down with Dr. James Klemis, interventional cardiologist with Stern Cardiovascular Foundation.
Q: What did researchers learn about low-dose daily aspirin?
“A team of scientists looked at trial participants who never had heart issues or cardiovascular events,” said Klemis. “The old way of thinking was that everybody should take aspirin—it was thought to be good for everybody. However, new evidence found low-dose daily aspirin should not be prescribed to most adults who are in good cardiovascular health. For patients who don’t have risk factors for heart disease, the risk outweighs the benefits.”
Q: What is the risk of taking daily aspirin?
“In general, long-term aspirin use thins the blood,” said Klemis. “There can be an increased risk of bleeding in some people. For example, the most common place you lose blood is through the gastrointestinal tract.”
If patients are concerned about internal bleeding or anemia, they can ask their doctor to check their blood count.
Q: Who should still take daily aspirin?
People who have heart disease or multiple risk factors, such as diabetes, high blood pressure and high cholesterol, should continue to take daily aspirin. Additional risk factors include being overweight, smoking and living a sedentary lifestyle.
“If you have heart disease, coronary artery disease or vascular disease—continue to take daily aspirin,” said Klemis. “There’s no question. Don’t stop taking it, particularly if you’ve had stents or bypass surgery. If you have risk factors for heart disease, but you’ve never had a heart event, talk to your primary care doctor. He or she can compare your risks to the guidelines and discuss a plan with you.”
For patients with a moderate or unknown risk of heart disease, doctors can perform a coronary heart scan, also called a heart calcium test. The test checks for plaque buildup—an indicator of cardiovascular health.
“A heart calcium test is a CT scan that looks at the arteries,” said Klemis. “It can detect early plaque buildup before a patient has a blockage or heart attack. Typically, patients with a positive calcium score show early signs of heart disease. If patients have a positive calcium score, I will treat them with daily low-dose aspirin and another prevention medication, such as a statin.”
Q: Who should stop taking daily aspirin?
“If you don’t have risk factors for heart disease and you’re getting regular checkups, you probably don’t need to take daily aspirin,” said Klemis. “Healthy adults who are 70 years old or older should not take daily aspirin if their reason is ‘just because’—especially if they have an increased risk of bleeding. Instead, consider making behavioral and lifestyle changes to ensure heart health.”
Q: What lifestyle changes can help lower the risk of cardiovascular disease?
“The American College of Cardiology and the American Heart Association provide guidelines for lowering the risk of cardiovascular disease,” said Klemis. “The most important way to prevent cardiovascular disease is adopting healthy habits, including physical activity. The guidelines recommend exercising five days a week for 30 minutes each day.”
In addition to regular exercise, Klemis and others recommend limiting calorie intake, avoiding sugar and processed foods, and continuing to maintain regular checkups with a primary care doctor.