Despite warnings, millions of seniors continue to use aspirin daily. A recent study revealed that 18.5 million older adults were still taking aspirin in 2021, with 3.3 million doing so without medical advice.
This widespread use raises significant health concerns.
An Aspirin a Day
Many older adults take daily low-dose aspirin to help prevent cardiovascular disease, warding off heart attacks and strokes. While this was thought to be a good common practice for those who are at risk for heart disease, new studies show that this recommendation could come with some unwanted side effects.
Three major aspirin trials have shifted the guidance and advice around the drug and is generally no longer recommending a daily aspirin.
Changing Guidelines
The American Heart Association and the United States Preventive Service Taskforce have changed their guidelines around daily low-dose aspirin in recent years. Now, these companies are recommending that aspirin isn’t right for all patients and carries some serious risks for some.
Despite this recommendation, new data reveals that Americans, especially those who are at high risk for heart harm, shouldn’t take aspirin daily.
Changing Recommendations for Aspirin Use
In 2018, health authorities revised their guidance on aspirin use for those over 60.
They highlighted that the risks of internal bleeding could outweigh the benefits for individuals without prior heart conditions. This change aimed to reduce unnecessary risks among seniors.
A New Look at Aspirin
“This practice was supported by evidence prior to 2018. It naturally takes some time for new data to percolate and reach physicians and patients and for these to translate into changes in management,” Mohak Gupta, MD, a Cardiology Fellow at Houston Methodist Hospital and First Author of the letter, told Healthline.
Gupta continued: “Potentially, there may also be a component of lack of awareness and hesitancy to change medical management.”
Aspirin’s History as a Preventive Measure
Aspirin has long been used to prevent heart attacks and strokes. Its blood-thinning properties help reduce clot formation, lowering the chances of cardiovascular events.
However, this same mechanism also increases the risk of internal bleeding.
Internal Bleeding Risks
Aspirin impairs blood clotting, which can lead to severe and life-threatening internal bleeding.
Such bleeds often occur in the stomach or intestines and can cause significant blood loss, shock, and damage to critical tissues. In rare cases, bleeding in the brain can be fatal.
Study Findings on Aspirin Use
Researchers analyzed data from 180,000 patients aged 40 and older between 2012 and 2021. This study, published in the Annals of Internal Medicine, shed light on aspirin use and its associated risks.
It involved data from the National Health Interview Survey (NHIS), covering health habits of 35,000 adults annually.
The Research
Gupta’s research used self-reported health data from 2012 to 2021, collected from a sample of 186,425 American adults, to represent the 150 million people who could be affected by this change.
More than half the participants were women, and about one-third were POC.
Preventive Benefits for High-Risk Individuals
For those who have already faced a heart attack or stroke, aspirin is a crucial ally. It can slash the risk of another cardiovascular event by about 25%.
However, if you haven’t had any prior heart conditions, the benefit isn’t quite the same.
The Increase Risks with Aspirin
Aspirin is a blood-thinner, which means that it has anticoagulant or antiplatelet properties that make it difficult for blood to clot.
While aspirin can help prevent heart attacks and strokes, it can also create other health issues, particularly an increased risk of bleeding.
A Bigger Risk for Older Adults
However, adults 70 years and older, are still using aspirin daily. This is important to note because the risks of bleeding become more prominent with age.
“The older adults are the most vulnerable since they are at higher risk of bleeding. They take more medications, and that can have more drug interactions with aspirin potentially causing more risk of bleeding,” Parul M. Goyal, MD, an Associate Professor of Medicine and Director of Medicine for Seniors at Vanderbilt University Medical Center who wasn’t affiliated with the study, told Healthline.
The Bleeding Risk
“The kind of bleeding that led to the change in guidelines was all kinds of bleeding. So it is falling and hitting your head, but it’s a lot of spontaneous bleeding in the stomach,” Eleanor Levin, MD, a Clinical Professor of Cardiovascular Medicine at Stanford Medicine, told Healthline.
“You have to consider again, in older people at risk of falls and head trauma, and increased intracranial bleeding, that if they haven’t had a stroke before, that you’re putting them at risk for bleeding,” Levin added.
Filling in the Gaps
The authors of the study write their findings have real-world implications. The result could change regulations surrounding aspirin, and fill the knowledge gap about these changes among patients, particularly older ones.
Healthcare providers will have to have serious conversations with their patients about how to reduce the risk of heart disease while steering away from an aspirin a day.
A New Conversation
“Doctors should engage in risk-benefit discussions with patients using aspirin for primary prevention, especially for adults 60 years of age and older, and discontinue aspirin where appropriate—such as in older patients, those at high bleeding risk,” said Gupta.
If you are over 60 and take aspirin daily, your doctor highly recommends discussing a new plan to help reduce your risk of heart disease.
Affordability and Accessibility of Aspirin
Aspirin is an affordable and accessible medication. Its low cost and easy availability contribute to its widespread use among seniors.
However, affordability should not overshadow the potential risks involved.
Aspirin Usage is Down
Compared to 10 years ago, fewer adults are using aspirin as the primary prevention of CVD, but the number of people using aspirin is still high.
The number of adults without CD who reported using aspirin was 14.4% down from 20.6% in 2021.
Unsupervised Aspirin Use Among Seniors
3.3 million older adults were reportedly taking aspirin without any medical recommendation in 2021.
This unsupervised use increases the risk of severe complications, highlighting the need for proper medical guidance before starting aspirin therapy.
Revised Guidelines for Aspirin Use
Health experts now recommend that individuals over 60 without prior cardiovascular events should avoid aspirin due to the risk of internal bleeding.
This nuanced approach aims to balance the benefits and risks, ensuring that aspirin is used only when absolutely necessary.
New Consideration for Primary Prevention Patients
“When we’re talking about primary prevention patients, there’s a little bit more risk-benefit consideration. Are we more likely to prevent that first heart attack or stroke, or are we more likely to actually cause a major bleeding episode using aspirin?” Donald Lloyd-Jones, MD, past President of the American Heart Association and Professor of Preventive Medicine at Northwestern University’s Feinberg School of Medicine, told Healthline.
“In secondary prevention, it’s crystal clear: you should be on aspirin, period,” he added.
The Role of Doctors in Aspirin Recommendations
Doctors may still suggest aspirin for individuals with significant arterial plaque or those who have experienced a heart attack or stroke.
These recommendations are based on a thorough assessment of the patient’s health history and risk factors.
The Impact of Aspirin on Public Health
About 7% of adults over 60 have experienced a stroke, which means 5 million people. Meanwhile, 14% of those aged 65 to 74 have had a heart attack, affecting 4.6 million individuals.
These numbers highlight the critical importance of heart health as we age and underline the importance of tailored medical advice for aspirin use.
You Don’t Have to Stop Taking Aspirin
While aspirin can cause other health issues, the study shouldn’t discourage you from taking it when needed.
“This paper should not make anyone stop any medication. It should make people talk to their doctor about why they are taking aspirin,” he said.
A Balanced Approach to Aspirin Use
Ultimately, the decision to use aspirin should be made in consultation with a healthcare provider. Considering the individual’s specific health history and risks is crucial.
As research continues to evolve, the balance between aspirin’s benefits and risks remains a critical discussion for millions of seniors and their doctors.
