Daily aspirin no longer recommended to prevent heart disease

Aspirin may be only ‘minimally beneficial’ and comes with an increased risk of digestive tract bleeding, says UCLA Health cardiologist Dr. Boback Ziaeian

Photo by Joshua Sudock/UCLA Health

A panel of disease-prevention experts says older adults who don’t have heart disease should not take daily low-dose aspirin to prevent a first heart attack or stroke, a shift from earlier guidance.

The U.S. Preventive Services Task Force, a panel of physicians who review scientific research to develop guidelines to improve Americans’ health, published new recommendations on April 26 advising against daily aspirin use for the prevention of cardiovascular disease in people age 60 and older.

Taking baby aspirin daily has been routine for millions of Americans looking to prevent a heart attack or stroke. Aspirin has blood-thinning properties that can reduce the likelihood of blood clots forming in the arteries. But these same properties can also cause ulcers and bleeding in the digestive tract.

The task force says in its new recommendations that low-dose daily aspirin to prevent cardiovascular disease (CVD) has a modest benefit for people ages 40 to 59 who aren’t at increased risk for bleeding.

It concludes that there is “no net benefit” of taking aspirin for primary prevention of heart disease in those 60 and older.

These updated recommendations are based on three recent randomized control trials finding that using aspirin for primary prevention of heart attack and stroke “showed no meaningful benefits and higher bleeding risks,” says Boback Ziaeian, MD, PhD, assistant professor in the division of cardiology at the David Geffen School of Medicine at UCLA.

Dr. Ziaeian was among the authors of the American College of Cardiology and American Heart Association’s “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease” that downgraded recommendations for aspirin use for primary prevention in high-risk patients.

Dr. Boback Ziaeian

“This was a fairly large reversal from older recommendations,” he says.

“We have since learned that in an era where we control hypertension and high cholesterol better for primary prevention, aspirin may be only minimally beneficial with an increased bleeding risk, especially for older adults,” Dr. Ziaeian says.

It’s important to note, however, that this new advice applies only to primary prevention in people without known cardiovascular disease.

“Aspirin remains important for secondary prevention of stroke and ischemic cardiovascular disease,” Dr. Ziaeian says.

Cardiovascular disease is the leading cause of death in the United States. Each year, more than 600,000 people experience a first heart attack and another 610,000 have a first stroke. Heart disease risk can be reduced by maintaining normal blood pressure, cholesterol and blood sugar levels, getting regular exercise and not smoking.

Learn more about the UCLA Health Cardiovascular Center.