An Aspirin a Day May Not Be a Good Idea, New Clinical Guidelines Say

March 20, 2019 Updated: March 21, 2019

If you are a healthy older person and take a low dose of aspirin every day, you may want to talk to your doctor about possibly ending that medication.

For decades, doctors across the United States have been telling their elderly patients that a daily low dose of aspirin could help prevent cardiovascular problems. But now, the American College of Cardiology (ACC) and the American Heart Association (AHA) have declared that it’s not a good idea.

In new guidelines released on March 17, experts from the ACC and the AHA said a daily 75 to 100 milligrams of aspirin should no longer be given as a way to prevent cardiovascular disease in healthy people older than 70 or any adult, due to a “lack of net benefit.”

“Low-dose aspirin for primary prevention [is] now reserved for select high-risk patients,” the guidelines stated.

(Tim Boyle/Getty Images)

How does aspirin prevent a heart attack? According to Mayo Clinic, aspirin interferes with your blood’s clot-forming process. It works on your blood’s clotting cells, called platelets, which helps seal the opening in your blood vessel to stop bleeding. Therefore it makes sense that aspirin could reduce the build-up of platelets and potentially reduce the risk of heart attack and stroke, which both involve clots.

However, a 2018 study published in the New England Journal of Medicine involving more than 19,000 people, mostly over the age of 70 in Australia and the United States, concluded that a daily low-dose of aspirin had no effect on prolonging life in healthy, elderly people. It also showed that those taking aspirin were more likely to have a major bleeding episode.

During the 4-year-long trial starting in 2010, roughly half of participants were given 100 mg of low-dose aspirin, while the rest were given a placebo. The result suggested that people taking low-dose aspirin were just as likely to die over the course of the study period than those taking a placebo. More importantly, people taking the aspirin showed a significantly higher risk of hemorrhages.

In general, aspirin’s benefits didn’t seem to outweigh its risks.

(14 Mostafa&zeyad/Wikimedia Commons [CC BY-SA 4.0])
The ACC now recommends that doctors only recommend aspirin to those who are at the highest risk for cardiovascular disease and the lowest risk of bleeding, according to a statement. For everyone else, doctors should continue to advise their patients to adopt a healthy lifestyle: don’t smoke, eat a balanced diet, and engage in physical exercise regularly.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” said Roger Blumenthal, co-chair of the new ACC/AHA guidelines, “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin.”

It’s worth keeping in mind that these are just guidelines based on what’s generally accepted now in the medical community, which means it’s possible they may change again in the future. No matter what the guidelines say, everyone should always talk to their doctor before any decision to initiate or terminate the use of any medication. A patient could ask their doctor, “Does my risk of bleeding cancel out my benefit from taking aspirin?” Regular communication between patients and their doctor is very important.