• By Alex Osiadacz

Why aspirin guidelines are changing when it comes to preventing heart disease

November 16, 2021
a young woman holding a glass of water and an aspirin or pain medicine tablet in her finger getting ready to drink and swallow it

New recommendations of an aspirin a day to prevent heart attack and stroke are in progress.

Although the U.S. Preventive Services Task Force has not issued a final recommendation on the use of aspirin in cardiovascular disease prevention, it's a good time for you to talk with your health care provider.

"Evidence is pointing to the fact that we're not seeing a benefit from using low-dose aspirin for reducing risk in patients who don't already have cardiovascular disease," says Dr. Demilade Adedinsewo, a Mayo Clinic cardiologist. "Further, the evidence has been pointing toward increased bleeding risk in older patients, specifically those older than 60 who take low-dose aspirin for primary prevention."

Based on research, Dr. Adedinsewo says that the task force is in progress of revising its recommendation about who should take aspirin for prevention of heart disease, namely among people who do not have a history of heart disease.

Dr. Adedinsewo says the proposed recommendations for aspirin use are as follows:

  • Patients, particularly those over 60, with no history of cardiovascular disease and who have not started a low-dose aspirin regimen for heart disease or stroke prevention, should not begin taking a low-dose aspirin without first consulting their health care provider.
  • Patients with documented cardiovascular disease, as well as those who have artificial heart valves or stents in their arteries, should continue their aspirin regimen, as prescribed by their health care provider. If patients are unsure if they have heart disease, they should discuss whether taking low-dose aspirin is appropriate.

Watch: Dr. Demilade Adedinsewo (pronounced Demi-lahd Ah-day-deen-shay-wo) shares thoughts on the recommendations about who needs to talk aspirin.

Journalists: Broadcast-quality video sound bites with Dr. Adedinsewo are in the downloads at the end of this post. Please courtesy: "Demilade Adedinsewo, M.D. / Cardiology / Mayo Clinic"

Dr. Adedinsewo says the U.S. Preventive Services Task Force's proposed guidance specifies low-dose aspirin should not be administered for primary prevention of atherosclerotic cardiovascular disease among adults 60 or older, or at any age if patients are believed to have an increased bleeding risk. Moreover, while low-dose aspirin might be considered in select, higher-risk adults 40–59, the decision to use aspirin for primary prevention of cardiovascular disease needs to be evaluated on a case-by-case basis.

"In the cardiovascular world, we've known that statins have a stronger cardiovascular benefit for primary prevention than low-dose aspirin, especially in the last three to four years with the release of three very large aspirin trial results," says Dr. Adedinsewo. "These research studies drive home the point that the benefits from low-dose aspirin were minimal to none and came at the cost of high bleeding risk."

The proposed recommendations are based on new evidence that has been published since previous guidance was last issued in 2016. Dr. Adedinsewo says it is not unusual for guidelines to change. "Everything that we do in medicine is evidence-based, so if there are more contemporary studies, more contemporary research that provides additional, stronger evidence, the guidelines tend to move as such."

In the proposed recommendation, the U.S. Preventive Services Task Force also calls for more research on the use of aspirin to prevent colorectal cancer.

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