A low dose of aspirin a day may not do as much good for the ageing heart as we’ve previously hoped. This week, an independent and influential group of experts announced their intention to downgrade their previous recommendation for some older people to take daily aspirin as a way to reduce their risk of cardiovascular problems. Instead, they’ve concluded that people over 40 shouldn’t take daily aspirin to prevent cardiovascular disease without a doctor’s recommendation, and they’re actively recommending that people over 60 not take preventive aspirin.
A daily low dose of aspirin (also called baby aspirin) has long been seen as a relatively safe way to lessen the risk of heart attack, stroke, and other cardiovascular diseases. The cardiovascular benefits of aspirin, which helps thin out the blood, were thought to outweigh the modest risk of increased bleeding. But over the years, evidence has accumulated to show that this equation may not be so simple.
While aspirin does seem to help people who have already experienced cardiovascular disease or are at high risk for it, recent studies haven’t found a clear net benefit for healthy people taking it to prevent their first episode. In one study, the bleeding harms of aspirin even appeared to overshadow any benefits it may have had otherwise for people over 70. Citing this newer research, the American Heart Association and American College of Cardiology jointly released guidelines in 2019 that only weakly endorsed daily aspirin use for people between the ages of 40 and 70 who had a high risk of cardiovascular disease and a low risk for bleeding. Essentially, though, they discouraged its preventative use without a doctor’s say-so, especially for people over 70.
The new draft guidelines released Tuesday come from the U.S. Preventive Services Task Force (USPTF), a government-appointed but independent panel of experts whose advice guides nationwide preventive care practices. And they’re in line with the recent decrees from major heart health organisations.
In 2016, the USPTF recommended that people in their 50s at high risk of cardiovascular disease and colorectal cancer but no increased risk of bleeding take daily aspirin (high risk defined as an estimated 10% chance of getting sick in the next 10 years). Those in their 60s were told that they should make an individual decision about their aspirin use, ideally through consultation with a doctor. But they avoided any recommendations for people in their 40s or over 70, citing the lack of strong evidence either way.
Now, however, they’re no longer recommending daily aspirin use for any age group, at least not uniformly. People between the ages of 40 and 60 worried about their cardiovascular risk should make their decision to take aspirin on a case by case basis, according to the USPTF. And those over 60 shouldn’t be told to take it as a way to stay heart healthy. People who are already taking daily aspirin, especially if they have preexisting heart disease, should talk to their doctors before stopping.
“There’s no longer a blanket statement that everybody who’s at increased risk for heart disease, even though they never had a heart attack, should be on aspirin,” Chien-Wen Tseng, a member of the national task force who is the research director of family medicine and community health at the University of Hawaii, told the New York Times. “We need to be smarter at matching primary prevention to the people who will benefit the most and have the least risk of harms.”
In making their assessments, the USPTF said that data from recent trials and ongoing population studies had changed their mind. They determined that only a small net benefit from preventive aspirin might exist for high-risk people age 40 to 60, while no benefit likely exists for people over 60. While the new guidelines mostly concern cardiovascular disease, they also supersede the previous cancer prevention advice as well. According to the USPSTF, there is now “insufficient evidence” to show that daily aspirin use reduces the risk of developing or dying from colorectal cancer.
These new guidelines are technically only a draft proposal, so there may be some changes to the final language. The USPSTF will be accepting public comment on their proposal until early next month.