Aspirin use in older adults inconsistent with guidelines, researchers find

Key takeaways:

• Among older adults who regularly used aspirin, 14% did not report a history of CVD.
• Routine users also demonstrated a lack of knowledge on the benefits and risks of aspirin.

Many older adults who regularly use aspirin do not have a history of CVD, demonstrating a lack of adherence to recent guidelines, according to a recent survey from the National Poll on Healthy Aging.

“Aspirin is no longer a one-size-fits-all preventive tool for older adults, which for decades it was touted as,” Jordan Schaefer, MD, MSc, an associate professor at the University of Michigan Institute for Healthcare Policy and Innovation, said in a press release. “This poll shows we have a long way to go to make sure aspirin use is consistent with current knowledge.”

In 2022, the U.S. Preventive Services Task Force updated its 2016 guidelines and advised against the initiation of low-dose aspirin for primary CVD prevention in adults aged 60 years and older. The task force recommending that the decision to initiate aspirin should be made on a case-by-case basis in adults aged 40 to 59 years with a 10% or greater 10-year CVD risk.

Similarly, the American College of Cardiology and the American Heart Association recommend against the use of regular aspirin in those without a history of CVD, those aged 70 years and older and in those at an increased risk for bleeding.

The researchers assessed aspirin use trends among older adults (n = 2,657) through an online and telephone-administered survey conducted from July 17 to Aug. 7, 2023.

Overall, 25% of adults aged 50 to 80 years reported regular aspirin use — classified as three or more times a week — whereas 42% of adults aged 75 to 80 years reported regular aspirin use.

Over half (51%) of older adults regularly started taking aspirin more than 5 years ago. Regular aspirin use was also more common in men compared with women (32% vs. 19%).

Among all adults aged 50 to 80 years, 14% reported regular aspirin use without a history of CVD compared with 11% who reported CVD history.

Over seven in 10 (77%) of those without a history of CVD started taking aspirin at the recommendation of their health care provider — and most of them said they were advised to do so by primary care providers (62%) — whereas 34% of all older adults started aspirin use on their own and did not consult with a health care provider.

Schaefer and colleagues also found that among adults aged 50 to 80 years, 97% and 95% believed that aspirin reduces their risk for heart attacks and stroke or transient ischemic attacks, respectively.

Additionally, 77% believed aspirin use helps with general health, 46% thought it relieves pain, 36% thought it reduces their risk for colon cancer and 31% thought it reduces their risk for dementia.

Just 17% of routine aspirin users without a history of CVD thought the risks of taking aspirin may be greater than the benefits, whereas nearly one in three of all routine users did not think aspirin use increased their risk for bleeding.

The findings show a need to educate the public on who should regularly use aspirin, along with the benefits and risks of routine aspirin use, according to the researchers.

“As guidelines change, it’s important for everyone over [the age of 40 years] to talk with their health care provider about their individual cardiovascular risk based on their family history, past health issues, current medications, recent test results like blood pressure, cholesterol and blood sugar, and lifestyle factors like smoking, physical activity and eating habits,” Geoffrey Barnes, MD, MSc, an associate professor at the University of Michigan Health System, said in the release. “Preventive aspirin use should be based on age plus these factors.”

References:

• Arnett K, et al. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.03.010.
• An aspirin a day? Poll of older adults suggests some who take it may be following outdated advice. https://www.eurekalert.org/news-releases/1036503. Published March 7, 2024. Accessed March 11, 2024.
• Aspirin use among older adults. https://ihpi.umich.edu/news/aspirin-day-poll-older-adults-suggests-some-who-take-it-may-be-following-outdated-advice. Published March 7, 2024. Accessed March 11, 2024.