Is Aspirin Right for You?

By Jane Farrell

A panel of medical professors has issued a final recommendation on taking aspirin as a preventive measure against heart attack or stroke, saying the drug should not be automatically prescribed to certain groups of patients.

The recommendation from the U.S. Preventive Services Task Force said that people aged 40 to 59 who are at higher risk for CVD (cardiovascular disease) but do not have a history of it should decide with their healthcare professional whether  to start taking aspirin as a preventive measure if they have not had a first heart attack or stroke.

People over 60 should not start taking aspirin to prevent a first heart attack or stroke, but the task force emphasized that this applies only to patients who have not started taking aspirin to prevent CVD and have no history of it. The task force emphasized also that people in this age group who are already taking aspirin should continue to do so.

Heart disease and stroke are leading causes of mortality 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 cause harm. The most serious potential harm is bleeding in the stomach, intestines, and brain, also

known as internal bleeding.

“People who are 40 to 59 years old and who don’t have a history of CVD but are at higher risk may benefit from

starting to take aspirin to prevent a first heart attack or stroke,” says Task Force member John Wong, M.D. “It’s

important that they decide together with their healthcare professional if starting aspirin is right for them

because daily aspirin use does come with possible serious harms.”

When deciding whether patients ages 40 to 59 should start taking aspirin to prevent a first heart attack or

stroke, healthcare professionals should take into account the patient’s CVD risk, chance of bleeding, and other

factors. The Task Force encourages shared decision making between healthcare professionals and patients so

that the decision made is best for a patient’s health and in line with the patient’s values and preferences.

“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,” says Task Force vice chair Michael Barry, M.D. “Because the chance of

internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age

group.”

Importantly, these recommendations are not for people who already have heart disease, have had a stroke, or

are already taking aspirin; these people should talk to their healthcare professional about their individual

circumstances. “We want to emphasize that 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,” Wong added.

The final recommendations were published in the Journal of the American Medical Association. The recommendation, along with an evidence summary, can be found on the task force website.  

The Task Force’s final recommendation statement and corresponding evidence summary and modeling study

have been published online in the Journal of the American Medical Association, as well as on the Task Force

website; click here.

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based

medicine that works to improve the health of people nationwide by making evidence-based

recommendations about clinical preventive services such as screenings, counseling services, and preventive

medications.

Wong is interim chief scientific officer, vice chair for Academic Affairs, chief of the Division of Clinical

Decision Making, and a primary care clinician at Tufts Medical Center. He is a professor of medicine at Tufts

University School of Medicine.

Barry is the director of the Informed Medical Decisions Program in the Health Decision Sciences Center at

Massachusetts General Hospital. He is also a professor of medicine at Harvard Medical School and a clinician at

Massachusetts General Hospital.