The risks of using daily aspirin as heart disease protection outweigh the benefits for seniors, the U.S. Preventive Services Task Force announced Tuesday in a major policy reversal. New evidence has also prompted the panel to lower the age that it advises aspirin initiation in at-risk adults.
Aspirin, long a mainstay for reducing the risk of cardiovascular events, is no longer recommended for that purpose in adults 60 and older with no history of cardiovascular disease (CVD), the task force said. The risks of taking the drug daily for the primary prevention of CVD outweigh the benefits in that older age group, it stated.
The new recommendations are a major shift from the panel’s last guidance update, published in 2016. At that time, it encouraged clinicians and patients to consider risks and benefits of primary preventive therapy on a case-by-case basis in that age group. The 2022 guidance not only takes daily aspirin therapy off the table for these seniors, but also lowers the age of initial use for at-risk adults to 40 from age 50.
The panel based its decisions on a review of the latest research, which showed that although aspirin does reduce the likelihood of nonfatal myocardial infarction and stroke in these vulnerable populations, it also increases the risk of dangerous bleeding events. Those can include gastrointestinal bleeding, intracranial hemorrhage and hemorrhagic stroke.
“The magnitude of the harms is small overall but increases in older age groups, particularly in adults older than 60 years,” USPSTF said in a statement regarding the guidance, which was published in JAMA Tuesday.
When to initiate aspirin therapy
The evidence also shows a small net benefit in a low daily dose of aspirin for primary prevention in adults aged 40 to 59 years of age. Patients in this age group should have a 10-year risk of CVD that is 10% or higher to qualify for the therapy, USPSTF stated.
“[T]he magnitude of the lifetime benefits is greater when aspirin is initiated at a younger age,” it said.
In these relatively younger adults, shared decision making between clinicians and patients should help determine use, USPSTF added. A “reasonable” dose of aspirin in these cases is 81 mg per day, it noted.
Hard stop at age 75
The new recommendations apply only to patients with no history — or signs or symptoms — of CVD, or of other conditions for which aspirin may be indicated, the task force emphasized.
Patients already taking aspirin for CVD prevention should talk to their clinician about their individual circumstances when deciding whether to continue therapy. Adults who choose to continue preventive aspirin after age 60 should consider stopping by age 75, it stated. Although net CVD benefits grow over time in the absence of a bleeding event, they become progressively smaller with advancing age due to risk.
In the meantime, other clinical groups continue to present alternative guidance. The American College of Cardiology, for example, states that low-dose aspirin may be considered in at-risk adults aged 40 to 70 years, if they are not at risk for bleeding.
Aspirin has been used for more than 70 years to help prevent CVD, the leading cause of mortality in the United States.