Do you really need a daily aspirin for heart health?

Decades ago, many doctors recommended older adults take a daily aspirin to prevent cardiac events, but since then the science has changed. Even so, a new study reveals that about one in six older Americans are using aspirin to prevent cardiovascular disease, even as national guidelines increasingly warn against its routine use in certain age groups. 

Published in the Journal of the American College of Cardiology, the study highlights how outdated perceptions and a lack of medical guidance are putting many at risk of potentially dangerous side effects.

Widespread use with limited oversight

The research, based on a survey of over 2,500 adults aged 50 to 80 conducted by the University of Michigan’s National Poll on Healthy Aging, found that nearly 17% use aspirin as their primary form of cardiovascular prevention. Almost 25% of these users began the regimen on their own, without a physician’s recommendation. In fact, 8% said they had never discussed their aspirin use with any healthcare provider.

“For some patients without a history of cardiovascular disease, the benefits of taking aspirin for primary prevention may be offset by an increased risk of bleeding, especially as patients get older,” said Dr. Jordan K. Schaefer, senior author and clinical associate professor at the University of Michigan Medical School.

Updated guidelines

While aspirin has long been associated with heart health, modern guidelines have become more nuanced. The American College of Cardiology and American Heart Association now advise against routine aspirin use for primary prevention in adults over 70. 

The U.S. Preventive Services Task Force similarly discourages initiating use after age 60 and recommends reconsidering its use around age 75.

Yet, the study found that many older adults still believe in aspirin’s general health benefits. Over 80% said the medication helped with their overall health, and 29% even thought it could reduce dementia risk. Meanwhile, only 68% acknowledged its increased bleeding risk.

“It appears that older adults taking aspirin may anticipate benefits beyond reducing the risk of cardiovascular disease and may not fully understand the added risk of bleeding,” said Dr. Mark D. Edwards, lead author and internal medicine resident at U-M Health.

Younger members of the study group, aged 50 to 69, were more than twice as likely to use aspirin preventively than those aged 70 to 80. Women and individuals from households earning $60,000 or more annually were also more likely to engage in this practice.

“Aspirin use is much more of a complex question than it once seemed, which is all the more reason why it is important to consult a healthcare provider when considering use,” said Dr. Geoffrey Barnes, a cardiologist and co-author of the study.

Experts involved in the study strongly advise that anyone over 40 should consult their doctor to assess cardiovascular risk, taking into account personal and family history. Doing so can ensure that preventive strategies are evidence-based and appropriately tailored, rather than reliant on outdated assumptions.