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A Cardiologist Explains Why Taking Daily Aspirin for Heart Attack Prevention Can Be Risky for Older Adults

Delilah Gray

April 29, 2022

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Researchers estimate that millions of adults in the United States take low-dose daily aspirin to prevent cardiovascular events, like heart attacks and stroke. However, you might not know that in 2014, the Food and Drug Administration (FDA) began recommending against the practice for people with no history of cardiovascular events. And recently, the United States Preventative Service Task Force (an independent panel of experts in disease prevention) recommended doctors stop suggesting daily aspirin to people 60 and older who want to prevent their first heart attack or stroke.

The decision is likely because cardiovascular disease is now more effectively treated with cholesterol, diabetes, and blood pressure medications, says Jennifer Haythe, MD, a critical care cardiologist at Columbia University Center. "Thus, the benefit of aspirin in low and moderate-risk groups and older people may not be what it once was and may, in fact, lead to increased rates of hemorrhagic stroke and gastrointestinal bleeding."

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Jennifer Haythe, MD, director of cardio-obstetrics and internist at NYPH/Columbia

Heart attacks occur when fat, cholesterol, and other substances, accumulate to form a plaque that blocks blood flow to the heart, the Mayo Clinic says. Additionally, blood cells bind together and form platelets that repair damaged blood vessels, but in some cases, they can form and block blood flow to your heart, the Mayo Clinic says. Aspirin interrupts the body's blood clotting abilities and can reduce the risk of heart attacks. Still, daily low-dose aspirin—about 75 to 150 milligrams—isn't a perfect preventative solution. There's evidence that people can experience internal bleeding as a result of aspirin therapy.

"The latest data suggests that the risk of bleeding is greater than the risk of cardiovascular disease in patients who are deemed low risk for cardiovascular disease and older people," Dr. Haythe says. However, these new recommendations don't apply to people who are already taking aspirin because of known coronary artery disease and a history of stroke, she says. And if you're already taking a daily aspirin to prevent a cardiovascular event, Dr. Haythe says you should talk to your provider before making any adjustments.

That said, the data showed benefits for people between the ages of 40 and 59 if you have an increased risk of heart attack or stroke. Even if you fall within this demographic, you should consult your doctor before starting a daily dose, Dr. Haythe says. Additionally, mixing aspirin with other medications, certain steroids, and antidepressants can have serious side effects, so it's essential to chat with your doctor about possible drug interactions.

If you've been taking your daily aspirin and you're wary about what to do now, please don't make any decisions on your own. Every situation is unique, and these guidelines should not override your doctor's advice. "Those who are unsure of why they take aspirin or believe it is for prophylaxis should talk to their doctor before stopping," Dr. Haythe says.

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