Why Are Doctors Backing Away from Prescribing Daily Low-Dose Aspirin?

For decades, daily low-dose aspirin was recommended for many adults to prevent heart attacks and strokes. However, recent guidelines have significantly changed this recommendation. Here's what you need to know about the evolving guidance on aspirin for cardiovascular prevention.

The Shift in Recommendations

In 2022, the U.S. Preventive Services Task Force updated its guidelines:

Adults 60 and older should NOT start taking aspirin for primary prevention of cardiovascular disease.
For adults 40-59 with 10% or higher 10-year cardiovascular risk, the decision should be individualized.
People already taking aspirin for secondary prevention (after a heart attack or stroke) should continue unless directed otherwise by their doctor.

Why the Change?

Several factors led to this shift:

Better Prevention: Modern treatments for high blood pressure, cholesterol, and diabetes have reduced cardiovascular risk, making aspirin's additional benefit smaller.
Bleeding Risk: Aspirin increases the risk of serious bleeding, particularly gastrointestinal bleeding and bleeding in the brain.
New Research: Large clinical trials (ASPREE, ARRIVE, ASCEND) showed that for many people, aspirin's bleeding risks outweigh its cardiovascular benefits for primary prevention.
Age Factor: Bleeding risk increases significantly with age, while the absolute benefit of aspirin decreases.

Primary vs. Secondary Prevention

It's important to understand the difference:

Primary Prevention: Taking aspirin to prevent a first heart attack or stroke in someone who has never had one.
Secondary Prevention: Taking aspirin to prevent another event in someone who has already had a heart attack, stroke, or has established cardiovascular disease.

The new guidelines primarily affect primary prevention. Aspirin remains important for secondary prevention.

Who Should Still Take Aspirin?

Aspirin may still be recommended for:

People who have had a heart attack or stroke
Those with coronary artery disease, stents, or bypass surgery
Certain patients at very high cardiovascular risk after individual assessment
Some people with diabetes at elevated cardiovascular risk

What Should You Do?

Don't stop aspirin on your own if your doctor prescribed it for a specific reason.
Talk to your doctor about whether aspirin is right for you based on your individual risk factors.
Focus on proven prevention strategies: blood pressure control, cholesterol management, healthy diet, regular exercise, not smoking, and maintaining a healthy weight.