Aspirin for Heart Disease Prevention: What the New Guidance Means

Trying to follow the ebb and flow of health guidance can be confusing, especially when it comes to daily medication recommendations. Benefits and risks depend on your personal health, and new medical research can always sway things in another direction. 

The US Preventive Services Task Force recently finalized its updated recommendation about daily aspirin use to prevent a heart attack or stroke. While the previous guidance was far from a blanket recommendation, some older adults might've decided to take an aspirin each day to help stave off coronary artery disease, heart attacks, strokes and other problems. Now, the Task Force, a panel of medical experts that issues guidance for preventative medicine, has adjusted its stance on aspirin and narrowed the scope of who might actually benefit.

Importantly, this guidance is for "primary prevention" of a "first heart attack or stroke" and not for people who've already been diagnosed with cardiovascular disease, including people who've had a heart attack, stroke or blocked artery. According to the Mayo Clinic, stopping taking aspirin or blood thinners when you've been directed to take them (like after a heart attack) has the potential to trigger a "rebound effect" and lead to blood clots or a heart attack.

The Task Force also hasn't adjusted the guidance for aspirin use when you suspect you're having a heart attack.

Here's what to know about aspirin guidance, and whether the tweaked recommendation warrants a phone call or office visit with your doctor.

What's the new guidance for daily aspirin? 

Adults who are age 60 and older who don't have cardiovascular disease and haven't gone through a cardiovascular event (such as a heart attack) shouldn't begin taking a low daily dose of aspirin.  

For adults who are ages 40 to 59 at a higher risk of cardiovascular disease (defined by the task force as having at least a 10% increased risk of cardiovascular disease within 10 years), the choice to start taking aspirin should be "an individual one." That is, you and your doctor can discuss the risks and benefits. Some people will have more of a benefit than others.  

The reason for this qualification is that a review of available research found that while there's a small benefit of daily aspirin use for reducing nonfatal strokes and nonfatal myocardial infarctions (heart attacks), it didn't have an effect on mortality. Aspirin also increases the risk of bleeding, including gastrointestinal bleeding and intracranial hemorrhage (bleeding in the GI tract or skull). 

Because bleeding risk increases with age, the Task Force decided older adults in their 60s and up won't get enough of a benefit from the aspirin to outweigh their increased bleeding risk.

If you're in your 60s or older and are already taking aspirin daily, talk to your doctor before deciding to stop taking it.

What was the previous guidance? 

The previous guidance was that adults ages 60 to 69 who don't have heart disease could decide with their doctor whether to take aspirin daily to reduce their risk of getting it. There wasn't a recommendation that they "shouldn't" start taking it, as there is now. 

Previous guidance also said that daily aspirin should be started in adults ages 50 to 59 who had a higher risk of cardiovascular disease, are "not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years." Again, this is no longer the guidance.

How does aspirin work to prevent heart disease? 

Aspirin has been used as a heart disease prevention tool in some cases because it interferes with the way blood forms clots. Blood clotting and building up in your veins can lead to a stroke, heart attack and other problems. 

Given its anti-clotting effect, aspirin continues to be a recommended tool to stop or slow a heart attack. 

Bottom line? 

The use of aspirin in people who aren't at a particularly high risk of cardiovascular disease has been debated among medical providers for years, so it's possible that if you call your doctor to weigh the adjusted guidance, their recommendation that you continue to take (or should stop taking) daily aspirin won't change. It also doesn't change other guidance for keeping your heart healthy, like daily walks, a diet rich in healthy fats, fruits and vegetables and practices that lower stress. 

"Evidence is pointing to the fact that we're not seeing a benefit from using low-dose aspirin for reducing risk in patients who don't already have cardiovascular disease," Dr. Demilade Adedinsewo, a cardiologist at the Mayo Clinic said in a November post by the hospital. Plans to update the guidance have been on the table for a while.

"Further, the evidence has been pointing toward increased bleeding risk in older patients, specifically those older than 60 who take low-dose aspirin for primary prevention."

As always, consult with a medical professional and consider your own health, risks and benefits, before starting or stopping any medication.