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Who Should Take a Daily Aspirin to Prevent First Heart Attack or Stroke?

Consensus among nation’s leading clinicians may be changing

October 25, 2021

An influential national medical panel is evaluating a question that impacts millions of Americans: should patients start a low-dose daily aspirin regimen to prevent a first heart attack or stroke?

The consensus among experts in prevention may be changing, as clinicians evaluate the benefits and risks across age groups. Aspirin may help prevent blood clots that clog arteries, but it also carries the risk for internal bleeding.

Earlier this month, the U.S. Preventive Services Task Force released draft recommendations evaluating the use of daily aspirin for people at high risk for cardiovascular disease. The task force is accepting public comments on its draft recommendations through November 8.

The recommendations would apply to those who are at higher risk and have no history of cardiovascular disease and are not already taking daily aspirin. They don’t apply to those who have already had a heart attack or are already on a daily regimen.

Among the notable takeaways from the proposed guidance: 

  • People 40 to 59 should decide with their clinician whether to start taking aspirin
  • People 60 or older should not start taking aspirin to prevent a first heart attack or stroke
  • More data is needed to routinely recommend aspirin as preventive measure against colorectal cancer. This recommendation was initially added during 2016

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” Dr. John Wong, a task force member said in a statement. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”

The task force also noted:

  • Clinicians should consider age, heart disease risk, and bleeding risk when deciding whether patients should start taking aspirin to prevent a first heart attack or stroke
  • It also is important to consider a patient’s values and preferences
  • People already taking aspirin should talk to their clinician about their individual circumstances

The new recommendations would narrow the guidance on daily low-dose aspirin to prevent a first heart attack or stroke in higher-risk patients.

During 2016, the task force recommended people between 50 and 59 with a 10 percent or greater ten-year risk for cardiovascular disease initiate a low-dose aspirin regimen and that it “should be an individual” decision for higher-risk people 60 to 69.

In a statement, Chien-Wen Tseng, MD, MPH, MSEE, added: “The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended. However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”

Heart disease and stroke account for about one in three deaths, the task force noted.

The Task Force’s draft recommendation statement and report have been posted for public comment.