New guidelines: Should you take daily baby aspirin to prevent a heart attack or stroke?

Oct. 15, 2021
Older man out hiking. Advice on daily baby aspirin is complicated.
There are new guidelines about who should take daily baby aspirin, also known as low-dose aspirin. Who needs it? It’s complicated. Photo: Getty Images.

Millions of American adults for years have 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 new proposed guidance from the U.S. Preventive Services Task Force.

That’s because the 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.

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.

To sort out confusion over the new guidance and to help you figure out if you should be taking daily baby aspirin, we consulted with Simon, who is an assistant professor of cardiology at the University of Colorado School of Medicine on the Anschutz Medical Campus in Aurora.

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 new guidance about daily baby aspirin?

Dr. Steven Simon is a cardiologist. He gives advice on daily baby aspirin.
Dr. Steven Simon. Photo: UCHealth.

Here are the new guidelines, which are currently in draft form and should be finalized by the end of the year:

  • 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 new guidance does not apply to everyone. Initial headlines might have made it seem like everyone should immediately stop taking baby aspirin. That’s not correct, Simon said.

“This applies to a very specific patient group,” he said.

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 continue taking a daily low-dose or baby aspirin.

This is also true for people who have had stents or coronary bypass surgery.

If you are at all confused, consult your doctor.

Remind me. What are the different kinds of stroke?

  1. 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 the result of ischemic strokes.
  2. A hemorrhagic stroke is the result of a blood vessel in the brain leaking or rupturing, resulting in bleeding in the brain.
  3. 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 them 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 risk of heart attacks and ischemic stroke,” Simon said.

What should younger people who have a 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 new 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 versus the risk of bleeding in a series of patient populations.

The pivotal research includes the following studies:

https://pubmed-ncbi-nlm-nih-gov.proxy.hsl.ucdenver.edu/30158069/
https://pubmed-ncbi-nlm-nih-gov.proxy.hsl.ucdenver.edu/30221595/
https://pubmed-ncbi-nlm-nih-gov.proxy.hsl.ucdenver.edu/30221597/
https://pubmed-ncbi-nlm-nih-gov.proxy.hsl.ucdenver.edu/30221596/
https://pubmed-ncbi-nlm-nih-gov.proxy.hsl.ucdenver.edu/30146931/

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.”

View patient resources related to coronary heart disease from the National Heart, Lung, and Blood Institute.

Review detailed recommendations from the American College of Cardiology and the American Heart Association.

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 will still be recommended to 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 with 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 used to be used for children, but this is no longer recommended. The proper name now should be low-dose aspirin, but many people still refer to the lower doses as baby aspirin.

If you are supposed to take baby aspirin, what is the proper dose?

In the United States, the most common dose is 81 milligrams.

Should you take baby 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 baby 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 with 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 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.

About the author

Katie Kerwin McCrimmon is a proud Colorado native. She attended Colorado College, thanks to a merit scholarship from the Boettcher Foundation, and worked as a park ranger in Rocky Mountain National Park during summer breaks from college. She is also a storyteller. She loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as a journalist at the Rocky Mountain News and was a finalist with a team of reporters for the Pulitzer Prize for their coverage of a deadly wildfire in Glenwood Springs in 1994. Katie was the first reporter in the U.S. to track down and interview survivors of the tragic blaze, which left 14 firefighters dead.

She covered an array of beats over the years, including the environment, politics, education and criminal justice. She also loved covering stories in Congress and at the U.S. Supreme Court during a stint as the Rocky’s reporter in Washington, D.C.

Katie then worked as a reporter for an online health news site before joining the UCHealth team in 2017.

Katie and her husband Cyrus, a Pulitzer Prize-winning photographer, have three children. The family loves traveling together anywhere from Glacier National Park to Cuba.

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