• Posted June 25, 2024

Despite Falling Out of Favor With Doctors, Daily Aspirin Still Popular

For decades, millions of Americans popped a low-dose aspirin each day to lower their heart risks.

Then, accumulated data prompted the nation's two leading cardiology groups -- the American College of Cardiology and the American Heart Association -- to overturn advisories in 2019 and recommend against daily aspirin, citing a risk for bleeding that exceeded any benefit for most people.

Trouble is, many Americans aren't heeding that message and continue to take the daily pill, a new survey finds.

The survey, from a sample representing over 150 million U.S. adults, found that almost a third of heart-healthy people age 60 or older said they took a daily low-dose (81milligrams) aspirin each day in 2021.

That's about 18.5 million older Americans, said a team led by Dr. Mohak Gupta. He's a physician in internal medicine who conducted the study while at the Cleveland Clinic. He's now practicing at Houston Methodist. 

Add in folks under 60 and the number rises to more than 25.6 million Americans taking daily aspirin, the researchers estimated.

Given aspirin's now dubious risk-benefit ratio for folks at average heart risk, "our findings highlight the urgent need for physicians to inquire about aspirin use, including self-use, and engage in risk"“benefit discussions to reduce inappropriate use for primary prevention in older adults," the researchers said.

They published their findings June 24 in the Annals of Internal Medicine.

As Gupta's team explained, data from trials published in 2018 cast doubt on prior recommendations for daily aspirin. That data instead showed a "limited benefit for primary prevention" when it came to heart issues.

"Therefore, the 2019 guidelines from the American College of Cardiology and American Heart Association discourage primary prevention aspirin use in adults older than 70 years," the team said.

Current advice from the American Heart Association (AHA) states that "because of the risk of bleeding, aspirin therapy is not recommended if you have never had a heart attack or stroke, except for certain select people."

The AHA now advises discussing your suitability for aspirin therapy first with your doctor, especially if you're over 70.

"If you're over 70, taking aspirin to prevent a first heart attack or stroke could do more harm than good," the AHA said.

There was a decline in the use of daily aspirin soon after the AHA and ACC altered their guidelines in 2019.

However, looking at 2012-2021 data from the National Health Interview Survey, Gupta's team found that "in 2021, 18.5% of adults aged 40 years or older [still] reported aspirin use for primary prevention." For those aged 60 or older, "a total of 29.7% reported primary prevention use."

About 1 in 20 (5.2%) of Americans aged 60 or older also told the survey they were using daily aspirin "without medical advice," the researchers noted.

According to the study, there does seem to be an ongoing trend among doctors to recommend that patients who take daily aspirin stop doing so.

However, the fact that so many Americans take aspirin runs counter to another important guideline change, the researchers noted.

The findings "have important implications in the context of guidelines from the U.S. Preventive Services Task Force in 2022, that also recommended against aspirin initiation for primary prevention among adults aged 60 years or older, as net harm may occur," Gupta's team wrote.

More information

Get the details on current guidelines on heart disease prevention from the American Heart Association.

SOURCE: Annals of Internal Medicine, August 2024