Guideline Update for Daily Aspirin Use

In the United States, Heart Disease has been the leading cause of death for over the past 80 years. For a long time, taking a simple baby aspirin per day has been used as primary prevention for developing heart disease. But over the last decade or so, doctors have started recommending baby aspirin for a more specific type of patient. On October 12th 2021, the U.S. Preventative Task Force (USPSTF) updated the guidelines to even further narrow the patient population that they recommend take daily aspirin.

Why has aspirin been used for preventing heart disease in the first place? Aspirin is an anti-platelet, and platelets are cells that clump together to form clots in our blood vessels. Basically, aspirin helps make our blood “less sticky.”

So who should and shouldn’t be taking a daily baby aspirin? First off, anyone who is already taking baby aspirin should continue their regimen and consult with their doctor before making any changes. One of the ways medical providers determine who is a good candidate for aspirin is by calculating their Cardiovascular Disease (CVD) Risk Score. The score is a percentage of risk for heart disease over the next 10 years. This is calculated based on several risk factors, including:

-Age (risk increases as we age)
-Diabetes
-Gender
-Race
-Smoking
-Cholesterol levels
-High blood pressure

With the new guideline update, the strength of recommendation for anyone age 40-59 with a 10% or greater risk of CVD has moved down to a C grade (it was a level A recommendation in 2002). This means that if you fall into this criteria, you should consult your doctor to weigh the pros and cons of daily aspirin therapy. This does not include those how have diagnosed heart disease, including those who have had a prior heart attack or ischemic stroke. For these patients with diagnosed CVD or a prior cardiac event, consult with your doctor before making any changes to your medications.

Another new change to the guidelines, is that the USPSTF does not recommend anyone over the age of 60 to take daily aspirin. This is due to the increasing evidence of the risk of gastrointestinal bleeding or hemorrhagic stroke. Again, please consult with your doctor before stopping any medications.

To summarize, for the people who are at a low risk of heart disease, the pros of aspirin therapy do not outweigh the cons. On the other hand, the higher that your risk of heart disease is, the more likely that the benefits of aspirin would outweigh the negatives.