Low-dose aspirin therapy became popular for several years as older adults with low- to moderate-risk of heart disease were often advised to take baby aspirin to help prevent a first heart attack or stroke. But recent studies have found that people in this group who take baby aspirin (81 mg) daily could be at risk for internal bleeding risks without any protection against heart disease.
According to a study published in the Annals of Internal Medicine, around 29 million people in the United States, aged 40 and older, regularly take aspirin. Among them, 6.6 million (24%) do so without their doctor’s recommendation. The researchers cited three randomized controlled trials that examined the supposed benefits of aspirin therapy in older adults. However, all three showed that while daily aspirin provided minimal benefit to users, it did lead to bleeding risks.
New Low-Dose Aspirin Guidelines
The American Heart Association issued a set of guidelines in March 2019 that advised against regular daily use of low-dose aspirin among healthy people who do not have any history of heart disease or stroke. The American College of Cardiology also contributed to the guidelines. Regular low-dose aspirin use in this group could cause more harm than good, the guidelines said. However, “ The new recommendation doesn’t apply to people who already have had a stroke or heart attack, or who have undergone bypass surgery or a procedure to insert a stent in their coronary arteries,” the guidelines state.
Internal Bleeding Is a Known Side Effect of Aspirin
Aspirin has long been known to cause internal bleeding in some people. Harvard Health Publishing reported in their November 2019 Harvard Health Letter that aspirin could cause problems in some patients. “It’s a big shake-up, based on three large studies,” Christopher Cannon, MD, stated in the press. Dr. Cannon is the director of education in Cardiovascular Medicine Innovation at Harvard-affiliated Brigham and Women’s Hospital, and a professor at Harvard Medical School in Boston. “Two of the three [studies] showed there was no benefit to taking daily aspirin to prevent a first heart attack or stroke, and aspirin was associated with an increased risk for bleeding severe enough to require transfusions or hospitalization,”
“The other study showed that in people with diabetes but no cardiovascular disease, there was benefit, but also risk: a 1% reduction in heart attack risk, and a 1% increase in bleeding risk,” he added.
The Take-Away
The biggest take-away from these findings is that there is still a place for aspirin therapy among older adults who have had a heart attack or stroke, but not for everyone. The studies and updated guidelines only discourage daily aspirin among those who are healthy and who don’t have any heart conditions.
This article is an update of Daily Aspirin Could Harm Healthy Older Adults, Offers No Benefit, published by Sadhana Bharanidharan, September 17, 2018.