FOR SEVERAL DECADES, doctors recommended that people in their 50s start taking baby aspirin every day to protect against heart attacks and stroke. But in recent years, with new evidence of the possible harm of daily aspirin, health experts changed those recommendations.

In major new guidance, a physician task force no longer recommends daily aspirin to prevent a first heart attack or stroke among people 60 and older. Meanwhile, the new guidance said people 40 to 59 should only take it if they have a high risk of cardiovascular disease, and in consultation with a doctor. There is little benefit in continuing aspirin beyond the age of 75 years old, experts concluded.

Heart disease and stroke are the leading causes of death in the United States, accounting for more than one in four deaths. While daily aspirin use has been shown to lower the chance of having a first heart attack or stroke, it can also increase the risk for bleeding in the brain, stomach and intestines. Although the absolute risk of a bleeding event is low, the risk increases with age.

Based on current evidence, the task force recommends against people 60 and older starting to take aspirin to prevent a first heart attack or stroke. Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group.

People who are 40 to 59 years old and don’t have a history of cardiovascular disease but are at higher risk may benefit from starting to take aspirin to prevent a first heart attack or stroke. It’s important that they decide together with their healthcare professional if starting aspirin is right for them because daily aspirin does come with possible serious harms.

It is important for everyone to understand that for the vast majority of people without pre-existing heart disease, aspirin does not provide a net benefit. The harms are approximately equal to any benefits.

The new recommendations were aimed at people who have not yet started taking a daily aspirin. The panel of experts did not issue guidance for people who are already taking a daily aspirin, and the updated news does not necessarily mean people should stop taking it if prescribed by a doctor.

These recommendations are focused on starting aspirin to prevent a first heart attack or stroke. Anyone who already takes aspirin and has questions about it should speak with their healthcare professional.

The new guidelines do not change for people who have had a heart attack, stroke or other major cardiovascular issue. The recommendation for using aspirin to protect them from a second event remains strong. Thus, the preventive services task force used to recommend people in their 50s at risk for heart disease take baby aspirin to prevent not only cardiovascular disease but also colon cancer. But updated recommendations based on additional research found benefits may not outweigh the risk, concluding the best colon cancer prevention is routine screening beginning at the age of 45. By Manny Palomar, PhD (EV Mail August 29-September 4, 2022 issue)