The US Preventive Services Task Force (USPSTF) has advised against people aged 60 and older taking aspirin for primary heart attack prevention because of their increased risk for bleeding into the brain or gastrointestinal tract (JAMA, published online April 26, 2022). People who do not currently take aspirin are advised to consider taking aspirin only if they are:
• ages 40-59 years with a greater than 10 percent risk of heart disease in the next 10 years
• age 60 and over and have had a heart attack
In October 2021, I reported on these new guidelines for the use of daily aspirin to prevent heart attacks when they were recommended by the USPSTF. In 2018, three large placebo-controlled clinical trials (ARRIVE, ASPREE and ASCEND) had found that aspirin is significantly less effective in preventing heart attacks than statins, diet, exercise and avoiding smoke and alcohol. The studies showed that:
• Aspirin offers the most benefit for people who have already had a heart attack
• People 40-59 years of age gain very little benefit from taking aspirin, but those with a greater than 10 percent predicted risk of a heart attack within 10 years gain a relatively small protective effect.
• People who are at increased risk for bleeding are at increased risk for aspirin causing strokes and gastrointestinal bleeding.
• The chances for serious bleeding increase with aging, particularly in those over 60 years of age. Doctors and patients should consider stopping aspirin use after age 75.
My Recommendations
If you are already taking aspirin to prevent a heart attack, check with your doctor about the slight protective effect of continuing on aspirin against your chances of bleeding into your brain or intestinal tract. The good news is that people who have taken aspirin for a long time and not had any bleeding problems are at reduced risk for bleeding in the future. The recommended dose for these people is a baby aspirin of 81 mg/day.
I think that everyone should try to prevent a heart attack by following an anti-inflammatory diet, trying to exercise every day, avoiding smoke, alcohol and recreational drugs, and avoiding overweight.
• Eat lots of vegetables
• Eat lots of legumes (beans, lentils, chickpeas, soybeans, peanuts) and nuts
• Eat whole (unground) grains and restrict refined grains (bakery products, pasta, white rice and so forth)
• Restrict mammal meat and processed meats.
• Eat seafood twice a week or more
• Avoid sugar-sweetened and artificially sweetened beverages
• Avoid sugar-added foods
• Restrict salt
• Restrict alcohol
