For years, millions of American adults had been taking a daily low-dose aspirin — or baby aspirin, as it’s commonly known — to prevent a heart attack or stroke.
But many older adults who are not at elevated risk for heart attack or stroke should not start taking daily baby aspirin, according to guidance from the U.S. Preventive Services Task Force released in 2022.
“Aspirin was previously thought of as a kind of ‘wonder drug,’ but over the years, we have learned that there are risks associated with taking aspirin,” said Dr. William Cornwell, who specializes in sports cardiology and exercise science at UCHealth Heart and Vascular Center – Anschutz Medical Campus in Metro Denver. “The biggest risk associated with aspirin is bleeding.”
Bleeding risks associated with taking daily baby aspirin increase as people get older and can outweigh the protective cardiovascular benefits for those who have never had a heart attack or stroke.
Even so, the advice is not as simple as it sounds.
“Whenever guidelines are developed, it is important to balance the risks and benefits,” said Cornwell.
Most people who have had strokes or a heart attack in the past should keep taking daily baby aspirin. It’s important for these patients to consult with their doctors.
“There are still many patients who potentially will benefit from taking a daily low-dose aspirin, including those who have already had a cardiovascular event and those who are at high risk for having one,” said UCHealth cardiologist Dr. Steven Simon, who is an assistant professor of cardiology at the University of Colorado School of Medicine on the Anschutz Medical Campus in Aurora.
To clarify the guidance and help you decide whether you should take daily baby aspirin, we consulted with Cornwell and Simon, as well as Dr. David Rosenbaum, who practices cardiovascular medicine at UCHealth Heart Clinic – Memorial Hospital North in Colorado Springs.
Why have adults been taking low-dose or daily baby aspirin in the first place?
Cardiovascular disease is the leading cause of death in the U.S., accounting for about one in three deaths, according to the Preventive Services Task Force. Each year, an estimated 605,000 Americans have a first heart attack and about 610,000 experience a first stroke. So prevention is key. And, for decades, doctors have often advised older adults to take daily baby aspirin to prevent heart attacks and strokes.
What is the guidance about daily baby aspirin?
Here are the guidelines about taking a daily dose of baby aspirin:
- Adults ages 60 and older who have not had a prior heart attack, stroke, stents or heart or artery surgery, or significant atherosclerosis (clogging of the arteries) should not start taking daily baby aspirin. That’s because there’s “no net benefit” when considering the associated bleeding risks, according to the prevention experts.
- People ages 40 to 59 who have a greater than 10% risk of having a stroke or heart attack over 10 years may get a “small net benefit” from taking a daily low-dose or baby aspirin. These people should consult with their doctors to weigh the pros and cons.
- People who have already had a stroke or heart attack and have been advised by their doctors to take a daily baby aspirin should continue with their aspirin regimen. Anyone with questions about their specific circumstances should consult with their doctor prior to stopping aspirin.
Simon emphasizes that the guidance does not apply to everyone. Initial headlines might have led people to think everyone should immediately stop taking baby aspirin. That’s not correct, Simon said.
“This applies to a very specific patient group,” he said.
“Aspirin works on platelets, which prevent bleeding. Aspirin inhibits platelet function, which lowers the threshold for bleeding,” Cornwell said.
Some patients should take aspirin, he added.
Who should continue taking baby aspirin?
“People who have had a heart attack or ischemic stroke absolutely need to stay on their aspirin,” Simon said.
If you have a history of heart disease or stroke in your immediate family or have had your own history of cardiovascular disease or atherosclerotic disease, your doctor may recommend you take a daily low-dose or baby aspirin.
“For select patients, who are 40 to 70 years of age, if those individuals are at high risk for a future event, then we might prescribe aspirin for primary prevention – ie, to prevent a first heart attack,” Cornwell said. “But for patients older than 70, it should generally not be given for primary prevention, because the bleeding risk is high.”
This is also true for people who have had stents or coronary bypass surgery.
Rosenbaum agreed.
“I don’t know that just anybody should be receiving aspirin regularly,” Rosenbaum said. “If someone has had a heart attack, a stroke or major vascular disease, they should be on aspirin as a secondary treatment. But the number of people who should be on aspirin shrunk by millions when this new guidance was released.”
If you are at all confused, consult your doctor.
What are the different kinds of stroke?
- An ischemic stroke is the result of decreased blood flow to the brain. It occurs when a vessel supplying blood to the brain is blocked. About 87% of all strokes are ischemic strokes.
- A hemorrhagic stroke is the result of a blood vessel in the brain leaking or rupturing, resulting in bleeding in the brain.
- A mini-stroke or transient ischemic attack (TIA) is caused by a temporary lack of blood flow to the brain. A TIA is an important warning sign, and patients should take it seriously.
How does a daily baby aspirin help with heart attack and ischemic stroke prevention?
Aspirin interferes with the process of forming a blood clot. While this is helpful for preventing a blood clot from forming in the heart or brain arteries, it is also why it increases the risk of bleeding.
“Aspirin has been shown to be beneficial for reducing the risk of heart attacks and ischemic stroke,” Simon said.
What should younger people who are at risk of heart disease do?
They should talk with their doctors and decide whether a daily dose of baby aspirin benefits them.
“Patients ages 40 to 59 who have a greater than 10% risk of having a stroke or heart attack over 10 years should have a patient-centered discussion with their doctor about whether to start using aspirin. There may be a small net benefit for them. This should be a patient decision based on bleeding risk versus cardiovascular risk,” Simon said.
How do you know if you are at greater risk for heart disease or stroke?
The risk of suffering a stroke or a heart attack increases with age. Family history, additional medical conditions, ethnic or racial background and lifestyle factors also play a role.
According to the U.S. Centers for Disease Control and Prevention, nearly half of Americans (47%) have at least one of the three key risk factors for heart disease: they smoke cigarettes, have high blood pressure or high cholesterol.
Who is most at risk for heart attacks and stroke?
Both age and sex affect risk. Older people are at greater risk of suffering heart attacks and strokes. Men tend to experience cardiovascular problems at younger ages than women.
And heart disease takes a greater toll on ethnic and racial minorities. Black Americans have among the highest rates of cardiovascular disease.
Which groups of people should not start taking baby aspirin?
“If you are over 60 and have no known atherosclerotic heart disease and you are not currently taking aspirin, these recommendations suggest you should not start taking aspirin. That’s a pretty narrow group compared to what the initial headlines suggested,” Simon said.
Why is the advice about baby aspirin changing?
The 2022 guidelines are not a surprise to experts. They have been in the works since data from a series of major clinical trials were released in 2018. These trials compared the benefits of cardiovascular risk protection with the risk of bleeding across a series of patient populations.
The pivotal research includes the following studies:
- Effect of Aspirin on All-Cause Mortality in the Healthy Elderly | New England Journal of Medicine
- Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus | New England Journal of Medicine
- Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial – PubMed
Simon said there is broad support among experts for the new guidelines.
“If you are over 60 and don’t have a history of heart or vascular disease, then the risk of bleeding likely exceeds the cardiovascular benefits,” Simon said. “The new recommendations are completely reasonable based on the available evidence, and generally are in line with recommendations from other medical groups.”
What should people over age 60 do if they’re confused about baby aspirin?
If you are confused about whether you are at greater risk for heart attacks and stroke, talk with your doctor. Many patients continue taking low-dose daily aspirin.
If you are in good health and have no history of cardiovascular disease, you should not start taking a daily low-dose or baby aspirin without consulting your primary care provider.
If I should not be taking baby aspirin, but previously started doing so, is it safe to stop suddenly?
Yes. Unlike some medications, which you should not stop taking abruptly, it is safe to stop taking low-dose aspirin without weaning off of it.
“If you are someone who should stop taking a daily low-dose aspirin, then you can stop it without weaning,” Simon said.
But, he urges caution for anyone whose doctor previously recommended a daily baby aspirin.
“I would not stop it without first talking with whoever prescribed it,” he said.
Is baby aspirin safe for babies? Why is it called baby aspirin?
Aspirin should not be given to babies and children except if prescribed by a doctor for rare medical conditions. The term “baby aspirin” stems from the lower dose that was used for children, but this is no longer recommended. The proper name now is low-dose aspirin, but many people still refer to lower doses as baby aspirin.
Should the average person still take aspirin for a headache?
According to Cornwell, “Aspirin has long been known to inhibit prostaglandin formation, a hormone that causes pain. When taken intermittently to treat a headache, it is probably okay.”
However, he hesitates to say that aspirin should be the “go-to” pain reliever for everyone.
“Be sure to speak with your doctor about the risks and benefits of using aspirin for pain relief,” Cornwell said, particularly for individuals suffering from frequent headaches. In these cases, Cornwell added, there are several different – and very effective – medications that can be used to treat a headache or even prevent one from starting in the first place.
“A single dose here or there as a pain reliever is likely benign if you don’t have any risk factors for bleeding. But there are other medications for pain relief.”
If you are supposed to take low-dose aspirin, what is the proper dose?
In the United States, the most common dose is 81 milligrams.
Should you take low-dose aspirin with food?
Yes. Aspirin can upset people’s stomachs, so if you are supposed to take it daily, it’s best to take it with a small meal.
What are the side effects of daily aspirin?
Bleeding is, of course, a possible side effect of taking a daily low-dose aspirin. So, if you are heading in for surgery or you are at risk of bleeding, be sure to tell your doctor about all medications you are taking, including baby aspirin.
Can low-dose aspirin cause ulcers?
Yes. Baby aspirin or a daily low-dose aspirin increases the risk of developing a stomach ulcer. If you already have a bleeding ulcer or gastrointestinal bleeding, do not take aspirin without consulting your doctor.
Is it possible to have an allergy to aspirin?
Yes. According to the American Academy of Allergy, Asthma and Immunology, some people are allergic to aspirin and can have hives, itching, swelling, shortness of breath, nasal congestion, wheezing or can even pass out. When these reactions are severe, the reaction is called anaphylaxis.
Is daily aspirin a blood thinner?
Yes. That’s precisely why it can help people who are at risk of blood clots, but it is dangerous for people who are at risk of hemorrhages or excessive bleeding.
If I want to prevent heart disease, a heart attack or stroke, what is the best advice for staying healthy?
Small steps can make a big difference. The Million Hearts Campaign urges people ages 55 and older to get on track with simple steps, like scheduling their medical appointments, getting physically active and eating a healthy diet. Get more ideas about taking simple steps to improve your health.
The American Heart Association recommends “Life’s Essential 8”:
- Eat Better: Consider the Mediterranean diet, which emphasizes fruits, vegetables, whole grains and healthy fats that come from olive oil or fish.
- Physical activity: Engage in 150 minutes per week of moderate intensity exercise.
- Quit smoking.
- Healthy sleep: Get 7-9 hours of sleep each night.
- Maintain a healthy weight.
- Control your cholesterol: Talk to your doctor about what your cholesterol target should be based on your risk factors.
- Control your blood sugar.
- Control your blood pressure.
“The American Heart Association has found that only 17% of U.S. adults have these metrics at ideal levels,” Rosenbaum said.