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Many older adults who regularly use aspirin do not have a history of cardiovascular disease (CVD), suggesting a lack of adherence to recent guidelines, according to new findings from the University of Michigan’s National Poll on Healthy Aging.¹

In the survey of more than 2600 adults aged 50 to 80 years, 25% of respondents reported regular aspirin use—classified as ≥3 times a week—and 14% reported regular aspirin use without a history of CVD.¹

In all, 57% of adults aged 50 to 80 years who reported taking aspirin regularly also said they do not have a history of CVD.¹

“Aspirin is no longer a one-size-fits-all preventive tool for older adults, which for decades it was touted as,” said Jordan Schaefer, MD, MSc, hematologist, Michigan Medicine, member of the National Poll on Healthy Aging team, in a press release. “This poll shows we have a long way to go to make sure aspirin use is consistent with current knowledge.”²

In 2022, the US Preventive Services Task Force updated its 2016 guidelines and recommended against the initiation of low-dose aspirin for primary CVD prevention in adults aged 60 years and older. The task force also recommended that the decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a ≥10% 10-year CVD risk be an individual one because evidence indicated that the net benefit of use was small.

“For those without a history of CVD who are already regularly taking aspirin, the USPSTF suggests it may be reasonable to consider stopping regular aspirin use around age 75 upon discussion with a health care provider,” noted Schaefer and colleagues.¹

In addition, the American College of Cardiology and the American Heart Association now recommend against the routine 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, according to the survey.¹

To gain deeper insight into aspirin use among older adults, Schaefer and the poll team asked a national sample of adults aged 50 to 80 years (n=2657) about their use of aspirin, reasons for use, and its perceived risks and benefits. The survey was administered online and via phone from July 17, 2023, to August 7, 2023.¹

FINDINGS

Overall aspirin use. Results showed that, overall, 25% of respondents aged 50 to 80 years reported regular aspirin use and 42% of those aged 75 to 80 years also reported regular use of aspirin.¹

“In addition to increased likelihood of use at older ages, men were more likely than women to take aspirin regularly (32% vs. 19%) as were those with fair or poor physical health (35% vs. 23% who reported excellent, very good, or good physical health),” added investigators.¹

Over half (51%) of older adults who reported regular aspirin use started taking it more than 5 years ago, 19% started 4-5 years prior, and 30% started within the past 3 years.¹

Use among older adults with and without CVD history. The poll team noted that among older adults who reported regular aspirin use, 43% indicated that they had a history of at least 1 CVD-related condition (eg, coronary artery disease, stroke).¹

Among all respondents, 11% reported taking aspirin regularly and having a history of CVD. Researchers added that this was more common for men (15% vs 7% for women), adults aged 65 to 80 years (18% vs 6% of those aged 50 to 64 years), those with annual household incomes less than $60 000 (16% vs 8% with incomes ≥$60 000), and those who said their activities were limited by a disability (16% vs 9% without such limitations).¹

Among older adults who reported regular aspirin use, 57% did not report a history of CVD, of whom 82% reported taking aspirin to prevent an initial myocardial infarction or stroke, according to the results.¹

Among all older adults aged 50 to 80 years, 14% reported regularly using aspirin without a history of CVD, which was more common for men than women (18% vs 12%) and for adults aged 65 to 80 years than those aged 50 to 64 years (18% vs 12%).¹

Recommendations for use. More than 7 in 10 (77%) of respondents without a history of CVD reported that they 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 without consulting a health care provider.¹

Perceived benefits, risks. Among adults aged 50 to 80 years who used aspirin, 97% believed that aspirin reduced their risk of myocardial infarction and 95% believed it reduced their risk of stroke or transient ischemic attack.¹

Researchers also stated that 77% of older adults said that aspirin helps with their general health, 46% said it relieved pain, 36% thought it reduced their risk of colon cancer, and 31% believed it lowered their risk of dementia.¹

“Health care providers should review recent guideline changes to make sure that they are discussing aspirin use with older adults in a way that is consistent with current recommendations,” stated Schaefer et al. “There is an important opportunity for health care providers to discuss, educate, and ensure the appropriate use of aspirin to maximize the benefits and minimize the harms of this commonly used medication.”¹

References:

• Aspirin use among older adults. University of Michigan National Poll on Healthy Aging. March 2024. Accessed March 13, 2024. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/192619/0347_NPHA-Aspirin-report-FINAL-03-06-2024-doi.pdf?sequence=4&isAllowed=y
• An aspirin a day? Poll of older adults suggests some who take it may be following outdated advice. News release. University of Michigan. March 7, 2024. Accessed March 13, 2024. https://ihpi.umich.edu/news/aspirin-day-poll-older-adults-suggests-some-who-take-it-may-be-following-outdated-advice