For context, other ‘B’ grade recommendations include screening for depression in postpartum women and mammograms for breast cancer screening in women aged 40 to 74 years old. ‘A’ grade recommendations include things like cervical cancer screening in women aged 21 to 65.
But later research found that the perks of taking a daily aspirin to lower the risk of cardiovascular disease weren’t as big as scientists previously thought. They also came with a higher risk of increased bleeding.
That sparked a big change in guidelines. In 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) recommended against taking aspirin as primary prevention, while noting that it might be considered only for adults aged 40 to 70 who were at higher risk of cardiovascular disease (and not at risk of increased bleeding).
This changed further when, in 2022, the latest USPSTF statement recommended that adults 60 and up avoid starting baby aspirin altogether.
Why did it change?
There are a few reasons. “Previous studies looking at the use of aspirin to prevent cardiovascular disease did not consistently show benefit, and the ones that did weren’t very strong,” says Jim Liu, MD, a cardiologist at The Ohio State University Wexner Medical Center. “Taking aspirin does have some risks as well, such as bleeding and gastrointestinal side effects. Therefore, aspirin is no longer widely recommended to help prevent cardiovascular disease.”
While this was happening, advances grew in preventing heart disease. “At the same time, our ability to address other risk factors like high cholesterol and high blood pressure has improved,” says Corey Bradley, MD, cardiologist at New York-Presbyterian/Columbia University Irving Medical Center. “The data showed us that focusing on these other risk factors was not only more effective but safer.”
Who should still take aspirin?
A daily baby aspirin may still help some people—just not everyone, Shah says. “The strongest evidence for baby aspirin once a day is for individuals who have already had an event—heart attack, stroke, or a stent placed,” Shah explains. “Outside of that, it does come down to individual risk counseling.”
Aeshita Dwivedi, MD, cardiologist at Northwell’s Lenox Hill Hospital, agrees. “One size doesn’t fit all,” she says. “I look at each patient individually and gauge the degree of their cardiovascular risk and risk for bleeding.” However, she says she will usually recommend baby aspirin for patients with moderate to severe atherosclerosis, or the buildup of plaque in the artery walls.
Ultimately, it’s best to talk to a healthcare provider if you’re concerned about your cardiovascular disease risk. They can take a close look at your health history and make personalized recommendations from there.
