Don’t Start Aspirin Regimen to Prevent Heart Attack, Stroke After Turning 60

Many older adults are not following new recommendations

Recent research, however, finds that many older adults are not heeding this advice. According to a March 2024 report from the National Poll on Healthy Aging, sponsored by AARP, 14 percent of adults ages 50 to 80 are taking aspirin regularly even though they have no history of cardiovascular issues. Twenty percent of them said they started doing it on their own, and 5 percent began taking aspirin based on the recommendation of family or friends. The poll also found that 31 percent of older adults who take aspirin don’t know about the associated bleeding risk.

Similarly, a study published June 25 in the journal Annals of Internal Medicine found that nearly one-third of older adults without heart disease reported in a 2021 survey that they took aspirin to help prevent it. One in 20 people were taking aspirin without medical advice.

One possible explanation for the disconnect: The latest USPSTF guidance pivots from previous recommendations issued in 2016, which suggested that people ages 50 to 59 with a certain level of risk for cardiovascular disease and a low risk for bleeding take a daily low-dose aspirin to reduce the likelihood of suffering a heart attack or stroke. The old recommendations also said that the decision to start taking aspirin for preventive reasons should be “an individual one” for adults ages 60 to 69 who are at risk for cardiovascular disease.

“Aspirin is no longer a one-size-fits-all preventive tool for older adults, which for decades it was touted as,” Jordan Schaefer, M.D., a hematologist at Michigan Medicine who worked with the poll team, said in a statement. “This poll shows we have a long way to go to make sure aspirin use is consistent with current knowledge.”

Poll director Jeffrey Kullgren, M.D., said the report’s findings should encourage more conversations between health care providers and patients about what works best for them. 

“We continue to urge clinicians to be extremely selective when prescribing aspirin for adults without known cardiovascular disease,” Donald M. Lloyd-Jones, M.D., former president of the American Heart Association, said in a 2022 news release. “For example, people with higher risk for gastric or intracerebral bleeding should not take aspirin to prevent a [cardiovascular] event. Aspirin should be limited to only those adults at the highest risk for cardiovascular disease due to the presence and severity of other risk factors, such as smoking, hypertension, type 2 diabetes, high cholesterol or significant family history, who also have a very low risk of bleeding.”

According to the American Heart Association, nearly half of American adults have some type of cardiovascular disease — a catchall term for conditions that affect the heart and blood vessels. Cardiovascular disease accounts for more than 1 in 4 deaths in the U.S. High blood pressure is the leading risk factor for the disease; diabetes, obesity and age can also increase risk.

The majority of all cardiovascular events may be prevented by managing risk factors and adopting healthy habits like exercising, not smoking and eating nutritious foods, Lloyd-Jones said. “The scientific evidence continues to confirm healthy lifestyle habits and effectively managing blood pressure and cholesterol are the top ways to prevent a first heart attack or stroke, not low-dose aspirin,” he added.

Editor’s note: This story, published Oct. 12, 2021, has been updated with new information.