USPSTF: Adults 60+ Should Not Start Taking Daily Aspirin

Last month, the United States Preventive Services Task Force (USPSTF) finalized its updated recommendations on daily aspirin use for older adults.

The new guidance states that people over the age of 60 should not start taking low-dose aspirin daily to prevent cardiovascular disease—specifically, a first heart attack or stroke.

USPSTF member John Wong, MD, interim chief scientific officer and primary care clinician in the Department of Medicine at Tufts Medical Center, told Verywell that when it comes to taking aspirin, experts “want people to be aware that there is the risk of having a serious bleeding event and that risk does increase as adults age.”

However, if you are between the ages of 40 and 59 years old, the task force advises that you ask your provider whether you’re at higher risk for having a first stroke or heart attack and if taking aspirin would be right for you.

Even for people who may benefit from taking aspirin daily, Wong said that the treatment increases the risk of serious bleeding events, including bleeding in the brain, stomach, and intestines (internal bleeding). 

“Whatever the leading risk is—whether that be a prior ulcer, medications that may predispose to bleeding events such as blood-thinning medication, liver disease, high blood pressure, or diabetes— taking a daily aspirin multiplies that risk,” said Wong. “As adults age into 60 and older, that multiplication effect gets magnified.”

Why Are The Guidelines Changing Now? 

The USPSTF updates its recommendations approximately every five years. The last update to its aspirin recommendations was released in 2016.

For many years, providers have recommended that older adults start taking low-dose or “baby” aspirin every day to prevent heart attacks and strokes. Some people also use aspirin to help prevent blood clots.

However, as researchers have learned more about aspirin and its effects through clinical trials and real-world experience from people who are taking the medication daily, they have made evidence-based suggestions for changing the guidelines.

Amit Khera, MD, an American Heart Association volunteer and the director of preventive cardiology at UT Southwestern Medical Center, told Verywell that the new USPSTF guidance is supported by three randomized clinical trials that were published in 2018.

The studies looked at aspirin use in patients who were at a higher risk for having cardiovascular disease:

• In the first study, the patients had diabetes
• In the second study, the patients had a higher estimated risk of having a first stroke or heart attack
• In the final study, older patients were included

Wong said that of the three studies, two found no significant reduction in first stroke or first heart attack with daily aspirin use. However, they did find an increased risk for major bleeding.

The study that included adults with diabetes found there was a reduction in cardiovascular or heart and brain events (including stroke and first heart attack) among the patients taking daily aspirin; however, Wong said the risk of major bleeding “counterbalanced that potential benefit.”

“Beyond the three studies, it’s pretty clear that bleeding events increase as adults get older,” said Wong. “And when we look at the totality of the evidence, we find that taking a low dose aspirin increases the risk for having a major gastrointestinal—that is, stomach or small bowel bleeding—by 60% and increases the risk for having bleeding within the brain by about 20% or 30%.”

The Guidelines Don’t Apply to Everyone

Wong said that the updated guidelines are meant for people who have not yet started taking daily aspirin—they do not apply to people who have already had a heart attack, stroke, or other major cardiovascular events.

People who are currently taking daily aspirin should not stop taking it if it was prescribed by a provider, as aspirin can provide some benefits.

However, Wong said people should ask their providers whether continuing to take aspirin is the best option for them.

“Some adults are taking it [aspirin] because they’ve had a stroke or heart attack. Once you’ve had a stroke or heart attack, then you’ve declared your higher risk potential for having another stroke or another heart attack,” said Wong. “The balance of harms and benefits is very different than if you’ve never had a first stroke or first heart attack.”

Khera said that patients who have had serious bleeding in the past or are at risk for it should not be taking aspirin to prevent a first heart attack or stroke. This could include people who:

• Have known ulcer disease
• Have had prior gastrointestinal bleeding
• Have had prior bleeding in the brain
• Are taking medications that promote ulcers and ulcer bleeding (e.g., certain steroids)

Aspirin might be an option for you if you’re between the ages of 40 to 59, your risk of bleeding is lower than older adults, and you have a significant risk of cardiovascular diseases.

Jennifer Wong, MD, a cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center, told Verywell that according to the guidelines providers “should still be considering aspirin” for people with those risks.

Should You Take Daily Aspirin?

Daily aspirin may help lower the risk for heart attack, stroke, and colorectal cancer and prevent blood clots; however, these benefits only apply to some people.

For example, Khera said people who are between the ages of 40 to 59 years old and have a risk of having a heart attack or stroke higher than 10% may benefit from taking aspirin every day.

In addition, daily aspirin may offer some benefits for people in that age group who have a higher risk of heart attack and stroke as long as they have not had bleeding problems before.

Wong said that younger people with a lower risk of bleeding, risk factors for cardiovascular disease, an increased risk of hypertension, diabetes, or strong family history of early cardiovascular events may also benefit from daily aspirin.

To determine your risk of a heart attack or stroke, Khera suggested an online assessment called the ASCVD Risk Estimator Plus.

“Anyone can look up what their risk of the next 10 years of having a heart attack or stroke is estimated to be,” said Khera. “And if it’s above 10%, then your risk is a little bit higher and aspirin may still be okay for you as long as you don’t have bleeding problems.

According to Khera, prescribing daily aspirin “shouldn’t be routine” for providers. “It shouldn’t be the default that we give aspirin—it should be more selective.”

Other Ways to Prevent Heart Disease

According to the Centers for Disease Control and Prevention (CDC), high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking, secondhand smoke exposure, a poor diet, physical inactivity, and obesity are the main risk factors for heart disease and stroke.

To prevent cardiovascular disease, experts like Khera encourage people to work on adopting healthy dietary habits, exercising, losing weight, quitting smoking, and lowering their cholesterol and blood pressure levels.

Wong said that providers can also screen patients for high blood pressure, prediabetes, and diabetes and start them on preventative measures and treatment when needed.

Other tools, like medications that lower cholesterol, can also help adults lower their risk of having a first stroke or heart attack.