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An Update on Aspirin Advice

By Chief Medical Officer Matt Narrett, M.D.
June 1, 2022
Bottle of aspirin

For more than 100 years, aspirin has been one of the most commonly used medicines for fever, inflammation, and pain. In the later part of the 20th century, when its effectiveness as a cardiovascular drug became evident, aspirin became part of a preventative treatment for heart attacks and strokes for many seniors.

In 2016, the U.S. Preventive Services Task Force (USPSTF) reviewed the existing body of scientific evidence surrounding aspirin. The USPSTF concluded that people under 70 - with an increased risk of cardiovascular disease - could benefit from starting aspirin therapy to prevent a heart attack or stroke. The same recommendation didn’t apply to seniors 70 and older, however, because they are more likely to experience aspirin-related side effects, most notably gastrointestinal bleeding.

Since that time, we have learned more about aspirin. Specifically, that younger seniors actually have a higher risk for bleeding than previously thought. Thus, in October 2021, the USPSTF lowered the recommended age from 70 to 60 as the cutoff for when the risks of taking aspirin outweigh the preventive cardiovascular benefits. It’s important to note that what did not change was the recommendation for seniors who previously had a heart attack or stroke. For that group, taking aspirin to prevent a subsequent cardiovascular event may be an effective therapeutic modality, and should be discussed with your health care provider.

Remember that recommendations don’t apply to everyone. One of the greatest challenges in the practice of medicine is applying statistics derived from research to each of us as individuals. This is particularly true when it comes to the aspirin decision, as there are clear benefits and risks, both of which are determined by your personal situation. You and your neighbor may be the same age, have the same cardiovascular risk, and have similar lifestyles, but aspirin may be a good choice for only one of you because of other factors. These include family history, individual response to medication, and health goals.

Although aspirin does not require a prescription and is a staple in most medicine cabinets, determining whether or not to take it is a difficult and complex decision. But one thing is certain: if you are already taking aspirin under the direction of your doctor, you should not stop. Nevertheless, if you want to know if you should continue to take it to prevent a future heart attack or stroke, please have a conversation with your doctor about your personal risks and benefits. Your medical condition changes over time, so while aspirin may have benefitted you at age 55, it might not make sense for you now at your current age.

Aspirin, the miracle drug introduced to the world in 1897, still raises important opportunities, questions, and appropriate concerns. Please have a conversation with your provider to share your needs, preferences, and the outcomes you’re seeking.

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