Study Finds Daily Medication Risky, Yet Popular Among Older Adults

A new study has revealed that taking a daily aspirin to prevent heart disease remains prevalent among older adults without heart issues, despite risks and updated guidance. 

For years, low-dose aspirin had been recommended for older adults as an effective tool to prevent heart disease. The medication helps thin the blood and prevent the formation of blood clots, which can cause heart attacks and stroke.

However, after research showed that it could also increase the risk of excessive bleeding and anemia in people without a history of heart issues, the American College of Cardiology and American Heart Association updated their recommendations in 2019 to say that people in that group should not regularly take aspirin for heart disease prevention.

The study suggests that, despite the shift, millions of adults without pre-existing heart problems could still be taking aspirin to ward off heart disease. 

“Aspirin has been used for decades for cardiovascular disease prevention,” Ashish Sarraju, MD, staff cardiologist at the Cleveland Clinic and senior author of the study, told Health. “So it is possible that some healthy older patients have been taking aspirin for years for prevention despite recent guidelines encouraging against this practice in a routine manner.”

Sarraju said the researchers had noticed that patients seem confused about whether they should be taking aspirin—some use it even if they're low risk for heart disease while others who should be taking it discontinue use.

“Because there was some sense of uncertainty about aspirin use in some of our patients, we decided to look at aspirin use trends,” Sarraju said.

Her team’s study, published late June in the Annals of Internal Medicine, included more than 180,000 people from the U.S. Centers for Disease Control and Prevention’s National Health Interview Survey. Most of those people—160,414—did not have heart disease.

After crunching the numbers, the team discovered that aspirin use to prevent first-time heart issues declined after 2018, when some aspirin-related guidelines changed. But in 2021, nearly a third of adults aged 60 or older were still using aspirin, and 5% were using it without medical advice. 

“It is safe to assume that many people are still taking aspirin out of habit, rather than checking in with the updated guidelines or their doctors to see if they should continue,” Christopher Davis, MD, chief cardiologist at Manatee Cardiovascular Wellness Institute and Reveal Vitality who was not involved with the survey, told Health. 

In a statement, the authors concluded that the findings “suggest a need to reduce inappropriate use of aspirin among older adults.”

However, the study had some limitations, such as relying on patients’ self-reported history of aspirin use and cardiovascular disease. Participants also didn’t provide enough information for researchers to assess their risk of cardiovascular disease or bleeding.

Additionally, the study period ended before the U.S. Preventive Services Task Force (USPSTF)—a group of independent experts that makes recommendations to guide doctors’ decisions—finalized its own updated guidance, largely aligning with the ACC’s and AHA’s. So, it’s possible that inappropriate use of aspirin has since declined.

According to the revised USPSTF recommendations, the decision to take daily aspirin should be individualized for adults aged 40 to 59 with a 10% or greater 10-year cardiovascular risk.

People “who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit,” the guidelines state.

While the task force previously recommended an individualized approach to aspirin use for people aged 60 and older without pre-existing heart issues, it now advises this group not to take low-dose aspirin because the risks—gastrointestinal bleeding, intracranial bleeding, and hemorrhagic stroke—outweigh the benefits.

However, many doctors still suggest a daily low-dose aspirin for people who’ve had a heart attack or stroke to prevent these events from happening again.

Despite the guidelines, Davis and Sarraju believe doctors should make decisions on a case-by-case basis.

“Though the guidelines exist, they should be kept in mind while treating patients individually,” Davis said. “Taking a comprehensive, holistic assessment approach to care with patients is key to determining best use.”

Added Sarraju: “Every medication is a balance of risks and benefits. This balance is always individualized, and no two patients are exactly the same, so the benefits and risks of aspirin should be evaluated on an individual basis rather than applying a single rule to all patients.”