Baby aspirin, also known as low-dose aspirin, refers to the use of aspirin at lower doses than generally used for pain relief. Typically, baby aspirin is taken at doses between 81 mg and 325 mg per day. The use of low-dose aspirin for heart health became popular in the 1970s after it was found to reduce the risk of heart attack and stroke in those at high risk. For decades, many cardiologists recommended the daily use of baby aspirin, even in healthy individuals, to help prevent heart disease. However, recommendations around baby aspirin have changed over the years as more research has emerged on both its benefits and risks. Here we will explore if cardiologists today still recommend daily baby aspirin for heart health.
Do the benefits of baby aspirin outweigh the risks?
Whether cardiologists recommend baby aspirin often comes down to weighing its cardiovascular benefits against its potential risks. Here is an overview of the evidence on both sides:
Benefits
- Reduces risk of heart attack and ischemic stroke in those at high risk – Baby aspirin is an antiplatelet and helps prevent clot formation. This provides a protective effect against heart attack and clot-related (ischemic) stroke.
- Lowers colon cancer risk – Some research shows daily baby aspirin use may lower long-term risk of developing colon cancer.
Risks and side effects
- Increased bleeding risk – Aspirin works as a blood thinner, so it can increase the risk of excessive bleeding or hemorrhagic stroke.
- Higher risk of stomach ulcers and bleeding – Baby aspirin can irritate the stomach lining and cause stomach ulcers or bleeding.
- Reye’s syndrome (in children) – Children and teens who take aspirin when they have a fever are at increased risk of the serious condition Reye’s syndrome.
- Allergic reactions – Some people are allergic to aspirin and can experience hives, facial swelling, asthma attacks, and other reactions.
Overall, research suggests the benefits outweigh the risks in those at high risk of cardiovascular disease. But in low risk individuals, the risks may outweigh the smaller potential benefits.
Have official recommendations on baby aspirin changed?
Major health organizations provide guidance to doctors on preventive care recommendations. Here is how official recommendations on daily baby aspirin use have evolved over time:
1989 – The U.S. Preventive Services Task Force (USPSTF) first recommends using low-dose aspirin to prevent heart attack in men over 50.
2009 – The USPSTF expands the recommendation to include women over 55 if benefit outweighs bleeding risk.
2016 – The USPSTF changes guidelines to recommend baby aspirin only in those over 50 with a 10%+ 10-year risk of heart disease. Not for lower risk individuals.
2021 – The USPSTF further narrows recommendation to only include 60-69 year olds at higher heart disease risk. Recommends against initiating aspirin in those over 70.
2022 – The USPSTF maintains its 2016 guidelines but is reviewing additional evidence. New draft guidelines expect in 2023.
Other groups like the American Heart Association and American College of Cardiology have similarly scaled back blanket aspirin recommendations in recent years. Usage should be personalized based on specific heart disease risk factors and likelihood of bleeding.
Do cardiologists still recommend it routinely?
Given the changing guidelines, cardiologists today take a much more measured approach to recommending daily baby aspirin compared to 20 years ago. Some key points on current cardiologist recommendations:
- No longer universally recommended – In the past, cardiologists widely recommended baby aspirin for heart health regardless of risk factors. This is no longer the case.
- Personalized based on cardiovascular risk – Cardiologists will assess factors like blood pressure, cholesterol, smoking, diabetes, family history to gauge an individual’s 10-year risk of heart attack or stroke before recommending aspirin.
- Generally not used for primary prevention in lower risk adults – For adults under 70 with low cardiovascular risk and no prior events like heart attack, aspirin is typically not recommended solely to prevent a first heart attack or stroke.
- Sometimes considered for moderate risk middle-aged adults – In certain 50-69 year olds with moderately elevated heart disease risk, some cardiologists may discuss potential benefits vs harms of baby aspirin. But it is not universally advised.
- Restricted in the elderly – Guidelines recommend against starting aspirin for primary prevention over age 70 due to increased bleeding risk in older adults.
- Still recommended for secondary prevention – Cardiologists widely recommend continuing aspirin indefinitely in patients with known cardiovascular disease (secondary prevention).
In summary, while cardiologists recognize aspirin benefits some patients, they no longer universally recommend its routine use for heart health in lower risk individuals without heart disease. Prescribing decisions are made on a case-by-case basis.
Why have recommendations changed?
There are a few key reasons daily aspirin is less routinely advised for heart health today compared to the past:
Lower cardiovascular risk in general population
With improved lifestyle changes, better treatments for conditions like high blood pressure, and falling smoking rates, the average person’s cardiovascular risk has decreased compared to 20-30 years ago. So the potential benefits of aspirin for primary prevention are lower, while bleeding risks remain.
Questions over mortality benefit
While aspirin reduces the risk of clot-related events like heart attack, its impact on cardiovascular mortality and all-cause mortality is less clear. Recent evidence reviews have questioned whether daily aspirin significantly lowers risk of dying from heart disease.
Better alternative heart medications
Improved cholesterol and blood pressure lowering medications have become frontline options for managing heart disease risk, displacing aspirin’s role over the past 20 years. Medications like statins are better supported by evidence for mortality benefit.
Increased focus on bleeding risks
As more data emerges on populations at higher bleeding risk with aspirin such as the elderly and those with peptic ulcers, guidelines have adapted to minimize these harms by discouraging routine aspirin without a clear benefit.
Specific patient populations to consider
While routine aspirin for primary prevention has fallen out of favor, there remain specific higher risk populations cardiologists may still consider aspirin for based on individual factors:
Those with 10%+ 10-year cardiovascular risk
In 50-69 year olds with over a 10% estimated risk of heart attack or stroke in the next 10 years, some cardiologists may prescribe a daily baby aspirin after weighing potential pros and cons. Risk is calculated using tools like the ASCVD Pooled Cohort Equations.
Patients with multiple risk factors
For adults in their 50s and 60s with a borderline or moderately elevated risk (5-10%) AND multiple cardiovascular risk factors like smoking, obesity, high cholesterol, etc., some cardiologists may recommend aspirin.
Diabetics over age 50
Patients over 50 with diabetes have an elevated cardiovascular risk. In some cases, cardiologists may advise daily aspirin for diabetic patients depending on their 10-year risk calculation and low bleeding risk.
Those at risk of blood clots
In individuals prone to developing blood clots, such as those with atrial fibrillation, DVT, or pulmonary embolism, cardiologists typically recommend baby aspirin to help prevent clot recurrence.
Is more research needed?
While evidence on aspirin for primary prevention has expanded significantly over the past 40 years, there are still areas of uncertainty where additional research could help refine clinical practice:
- Optimal dose and duration – Most studies look at standard ~100mg daily aspirin. More data on effects of lower doses and sporadic vs daily usage could inform prescribing patterns.
- Benefits by cardiovascular risk level – Future studies to clarify benefits in narrowly defined risk groups (5-10% 10-year risk, for example) could improve aspirin targeting.
- Outcomes by age – More evidence on aspirin’s impact on those over 70 could help determine if it has a role in older adults despite increased bleeding risk.
- Role in diabetes and cancer prevention – Ongoing research may elucidate whether aspirin helps prevent first heart attacks in diabetics or reduces cancer risk in healthy individuals.
As guidelines continue to evolve, further controlled studies can help provide clarity where some uncertainty remains around proper aspirin use for cardioprotection.
Conclusion
While baby aspirin was once widely recommended for heart health regardless of risk factors, guidelines have shifted significantly over the past decade. Today, cardiologists take a much more measured approach and prescribe low-dose aspirin only in certain higher risk groups where likely benefits are deemed to exceed potential harms of bleeding. Routine aspirin for primary prevention is generally no longer advised in healthy low risk adults, especially those over 70. Additional evidence may continue to refine recommendations around optimal patient selection and proper aspirin dosing for cardioprotection.