Poll Reveals Aspirin Overuse Despite New Guidelines Warning of Bleeding Dangers

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Millions of seniors pop aspirin every day, hoping to stave off heart attacks, but mounting evidence suggests that many are needlessly putting themselves at risk of potentially life-threatening bleeding.

A new poll reveals that more than half of older Americans taking aspirin have no history of cardiovascular disease and are taking the over-the-counter drug based on antiquated advice that the benefits outweigh the dangers for most older adults.

Rethinking Aspirin Use and Recommendations

The University of Michigan National Poll on Healthy Aging found that 57 percent of people ages 50 to 80 who take aspirin have no history of cardiovascular disease, which includes several heart and blood vessel problems. Only 11 percent of those taking aspirin as a preventive measure had such a history.

For decades, the U.S. Preventive Services Task Force (USPSTF), an independent panel of medical experts, recommended low-dose aspirin for people at considerable risk of heart attack. Over time, research has demonstrated that aspirin benefited high-risk patients who were older and had diabetes or additional cardiovascular conditions.

Moreover, across multiple studies, the findings showed that aspirin provided minimal clinical benefit for most people, as the modest potential advantages were outweighed by an increased risk of bleeding complications.

Recommendations on aspirin use have recently changed. In 2022, the USPSTF advised against routine aspirin use for heart attack prevention in adults ages 60 and older. Furthermore, the independent group stated that even for those ages 40 to 59, the “net benefit of aspirin use in this group is small.”

Randomized Trials Sound Alarm on Aspirin’s Bleeding Hazards

The USPSTF’s revised recommendations stem from new data highlighting the bleeding risks associated with aspirin use in clinical trials and studies.

An analysis of a randomized clinical trial involving more than 19,000 older adults revealed a statistically significant 38 percent higher risk of intracranial bleeding, including hemorrhagic stroke and other causes of intracerebral hemorrhage, among participants randomized to take aspirin.

Notably, in a separate analysis of 10 studies, aspirin use was linked to a 58 percent increased risk of major gastrointestinal bleeding.

The USPSTF found that the risk of bleeding occurred regardless of age, sex, race, ethnicity, level of cardiovascular disease, or presence of diabetes. However, the organization noted that “although the increase in relative risk does not appear to differ based on age, the absolute incidence of bleeding, and thus the magnitude of bleeding harm, increases with age, and more so in adults 60 years or older.”

Currently, the USPSTF, along with the American College of Cardiology, recommends daily low-dose aspirin for people at increased risk of cardiovascular disease but not at increased risk of bleeding.

Risk of Bleeding Relatively Unknown

According to the University of Michigan poll, 42 percent of adults ages 75 to 80 are taking aspirin. However, 31 percent of those taking aspirin are unaware of the associated bleeding risks.

“Aspirin is no longer a one-size-fits-all preventive tool for older adults, which for decades it was touted as,” Jordan Schaefer, a hematologist at Michigan Medicine who was part of the poll team, said in a statement. “This poll shows we have a long way to go to make sure aspirin use is consistent with current knowledge.”

Older people taking aspirin should consult their health care providers about the medication’s benefits and risks. About 71 percent of older adults who take aspirin have been doing so for four years or more, indicating they may be following outdated advice, the authors noted.

With aspirin guidelines changing, it’s important for adults older than 40 to consult their doctors about their personalized cardiovascular risk profiles, according to Dr. Geoffrey Barnes, a cardiologist at Michigan Medicine who also worked on the poll.

This evaluation should consider family medical history, previous health conditions, current medications, recent clinical markers such as blood pressure, cholesterol levels, and blood sugar readings, and modifiable risk factors such as smoking status, exercise habits, and dietary patterns, he said in a statement. Any decision on preventive aspirin therapy must be based on one’s age in conjunction with this constellation of risk factors, Dr. Barnes said.