Aspirin for Prevention of Cardiovascular Disease

Aspirin is sometimes used to help prevent people from developing cardiovascular disease.

For different reasons, millions of people take low-dose aspirin every day. For people who have had a heart attack, a stroke, placement of a coronary artery stent, or coronary artery bypass graft surgery, there is strong evidence that aspirin helps prevent another such event. This use is called secondary prevention: making an already diagnosed disease less likely to get worse.

Aspirin is also sometimes used for primary prevention: to prevent people from developing cardiovascular disease in the first place. However, recent studies and guidelines indicate that few people benefit from using aspirin in this way.

The main risk is bleeding, especially from the stomach or intestines. Such bleeding is rarely fatal, but it can lead to serious illness and hospitalization. In general, people taking blood thinners or who have a history of major bleeding should not take aspirin. Even low-dose baby aspirin can increase bleeding risk.

New guidelines about the prevention of cardiovascular disease were published in 2019 by the American College of Cardiology and the American Heart Association. These guidelines were endorsed by several major medical societies. The new recommendations about aspirin use were based on 3 recent major studies. These studies showed no benefit and even some harm as a result of using daily low-dose aspirin in some groups of people previously thought to benefit from such therapy. This new information applies to patients who do not have known cardiovascular disease.

First, the new guidelines are clear about who should not be taking low-dose aspirin to prevent cardiovascular disease. Patients who are older than 70 years, younger than 40 years, or at high bleeding risk because of another medical condition or medication should not be taking aspirin. Medical conditions that increase bleeding risk include previous gastrointestinal bleeding, peptic ulcer disease, blood clotting problems, and kidney disease. Medications that increase bleeding risk include nonsteroidal anti-inflammatory drugs, steroids, and other blood thinners.

Which patients may still benefit? Some adults between ages 40 and 70 years at high risk of developing cardiovascular disease and at low risk of bleeding may consider taking low-dose aspirin. Factors that put someone at risk of developing cardiovascular disease include smoking, a strong family history of heart attack, and uncontrolled blood pressure, cholesterol, or diabetes.

• If you have had a heart attack, a stroke, a coronary stent, or coronary artery bypass graft surgery, you should keep taking aspirin. The new studies and guidelines do not affect the importance of this treatment for you.

• If you have not had one of the above conditions or procedures and are older than 70 years, younger than 40 years, or at increased risk of bleeding because of a medical condition or medications, you should not take aspirin for primary prevention of heart disease.

• If you are between 40 and 70 years old, at low risk of bleeding, and thought to be at high risk of heart disease, you might benefit from aspirin. This is an area where personal preferences matter. Talk to your doctor to help decide whether taking low-dose aspirin makes sense for you. Most healthy adults do not need aspirin.

Finally, beyond aspirin, continue to take other important steps to improve heart health and enjoy a longer, healthier life. Such steps include eating a healthy diet, exercising, not smoking, and controlling high cholesterol, high blood pressure, and diabetes.

Conflict of Interest Disclosures: None reported.

Source: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596-e646.