Many older adults take aspirin for heart disease prevention without doctor’s advice

Around 1 in 6 older adults take aspirin as their primary method of preventing cardiovascular disease – despite stricter guidelines that no longer always call for it, a study finds. 

Almost one-quarter of those aspirin users started taking the medication without a physician recommendation and 8% had not discussed their use with any health care provider. 

The results, published in the Journal of the American College of Cardiology, come from a survey of more than 2,500 adults aged 50 to 80 conducted for the University of Michigan’s National Poll on Healthy Aging. The new paper builds on a previous poll report, with additional analysis. 

“For some patients without a history of cardiovascular disease, the benefits of taking aspirin for primary prevention may be offset by an increased risk of bleeding, especially as patients get older,” said Jordan K. Schaefer, M.D., senior author and clinical associate professor of internal medicine-hematology at University of Michigan Medical School. 

“It is even more concerning when patients are taking aspirin without consulting their physician. A provider can’t help a patient understand the risks and benefits of aspirin if they are left in the dark.” 

In the past decade, guidelines for who should take aspirin for cardiovascular reasons have been revised to reduce the situations in which it’s recommended. The changes were informed by newer research that highlighted significant bleeding risk associated with using the medication for primary prevention – that is, by people with no history of heart attack or other heart disease. 

The American College of Cardiology and the American Heart Association advise against routine primary prevention aspirin use after age 70. The U.S. Preventive Services Task Force also recommends not starting aspirin for primary prevention after 60 and potentially stopping around age 75. 

While the vast majority of primary prevention users in the study believed that aspirin reduces their risk of heart attack, just 68% agreed that it increases the risk of bleeding. 

Just over 80% of respondents said aspirin helped with general health, and 29% believed it reduced the risk of dementia. 

It appears that older adults taking aspirin may anticipate benefits beyond reducing the risk of cardiovascular disease and may not fully understand the added risk of bleeding.” 

Mark D. Edwards, M.D., first author and internal medicine resident at U-M Health

The younger survey participants, between the ages of 50 and 69, were more than twice as likely to take aspirin for primary prevention compared to those aged 70 to 80 years. 

Women and those with a household income $60,000 or greater were also more likely to be primary prevention users. 

“Aspirin use is much more of a complex question than it once seemed, which is all the more reason why it is important to consult a heath care provider when considering use,” said Geoffrey Barnes, M.D., M.Sc., co-author and associate professor of internal medicine-cardiology at U-M Medical School. 

“I would recommend that anyone over 40 years old talk to their provider about their risk for cardiovascular disease, with careful consideration of family and health histories.”