Many elderly people are unknowingly putting themselves at risk of internal bleeding by taking low-dose aspirin preventatively, a new research discoversalthough it is no longer recommended by health authorities unless elderly people already have cardiovascular disease.
About a third of adults ages 60 and older said they routinely take aspirin when they shouldn’t, according to the study, published in JAMA on June 24. This means that around 18.5 million people are taking a medicine that poses more risk. than benefit to your health.
For many years, the conventional wisdom was that “an aspirin a day keeps the doctor away,” reducing heart attack risks. Doctors no longer think the benefits of taking low doses of aspirin daily outweigh the risks for people who don’t already have heart disease — but daily practices haven’t caught up, the study suggests.
Here’s what you should know about the new research and whether you should take low-dose aspirin daily.
What did the study find?
Cleveland Clinic researchers surveyed more than 186,000 adults ages 40 and older in the U.S. about their aspirin use in 2021. Nearly 20% said they used aspirin for “primary prevention,” meaning to prevent a first heart attack from occurring or leakage. Rates were even higher among those aged 60 and over: just 30% used aspirin for this purpose.
More than 5% of people taking aspirin for primary prevention did so without advice from their doctors, while the other 95% had told their doctors they were using the medicine without a prescription or were advised to take it by their doctors.
Why is this a problem?
In the 1990s, a series of research suggested that taking low-dose aspirin regularly could reduce the risk of having a first heart attack or stroke by preventing one of its most common causes: blood clots. However, this has never been without risk. “The way aspirin works is basically against an enzyme called cyclooxygenase,” which plays a key role in clot formation, Dr. Prashant Vaishnava, preventive cardiologist at Columbia University Irving Medical Center, told Yahoo Life. “Through this inhibition, it actually increases the risk of bleeding because it makes it less likely for platelets to clump together,” a phenomenon that normally helps stop internal bleeding, he explains.
Studies from three decades ago suggested that the risk of bleeding – particularly in the gastrointestinal tract – was worth it, given the benefits in preventing heart attacks and strokes. But research published in 2018 turned that thinking upside down, especially for older people. “The decision to treat with any medication is essentially a balancing act between the benefits and risks of that medication,” Dr., senior resident physician at the Cleveland Clinic and co-author of the new study, told Yahoo Life. “The benefits of aspirin in primary prevention are smaller and the risks are greater than we previously knew.” As a result, the U.S. Preventive Services Task Force (USPSTF) changed its recommendations for aspirin use in 2022.
Who should take low-dose aspirin daily?
The benefits of aspirin are still considered to outweigh the risks for people who have already been diagnosed with cardiovascular disease, including anyone who has ever had a heart attack or stroke. This is known as “secondary prevention”, meaning the goal is to prevent additional dangerous cardiac events.
Aspirin in low daily doses is recommended for people between 40 and 59 years old who have already taken have had a heart attack or stroke or have more than a 10% chance of having one in the next decade, according to the USPSTF.
“If you take aspirin because you have known cardiovascular disease, you should take aspirin,” Dr.Marta Gulati, director of prevention at Cedars-Sinai Heart Institute, emphatically told Yahoo Life. She notes that after the USPSTF changed its recommendations, there were “a horrible few weeks” when patients who should have been taking aspirin stopped. She warns against a repeat of that era.
Who shouldn’t be taking aspirin?
For those who have not been diagnosed with heart disease and are at lower risk of a heart attack or stroke, and for anyone age 60 or older who does not have heart disease, taking low-dose aspirin is not worth the chance of internal bleeding, according to the USPSTF. “We don’t have a good answer as to why [older people are particularly at risk]but we know that aspirin alone leads to changes in the gastrointestinal tract that increase the risk of bleeding”, explains Gulati.
What can people without heart disease do to reduce their risks?
The experts’ advice is simple and familiar: Eat a heart-healthy diet, don’t smoke or try to quit smoking if possible, stay active and keep your cholesterol and blood pressure in check, they told Yahoo Life.
“Talk to your doctor about things in your lifestyle that you should do regularly to keep your body healthy,” advises Gulati, especially if you’re 60 or older. For example, “just keep your body moving because exercise is always an independent predictor of mortality and cardiovascular mortality,” she says.
And don’t forget to “maintain social support”, he adds. Gulati says many of her older patients have lost friends and spouses, so she recommends they make younger friends. “Elderly people need social support and not to be alone [because it can lead to] depression, and depression can also affect heart health.
