The prevalence of daily low-dose aspirin use fell significantly after the American College of Cardiology and the American Heart Association narrowed recommendations in 2019. However, new research published today in JAMA shows that message has not reached all population segments equally, leaving some groups at greater risk of adverse effects like gastrointestinal bleeding and intracerebral hemorrhage.
It was long believed that taking a daily low-dose aspirin could prevent heart attack and stroke, while offering little downside to those not at high bleeding risk. That assumption was overturned in 2019, and daily use is now only recommended to be considered for people at elevated risk for atherosclerotic cardiovascular disease who do not have bleeding risks and are under 70 years of age.
"Many people are still taking a daily
aspirin without proven clinical benefit," said senior author Timothy S. Anderson, M.D., MAS., assistant professor of medicine at the University of Pittsburgh. "Moreover, long-term aspirin use carries small but serious risks of bleeding."
Researchers analyzed data from the National Health and Nutrition Examination Survey from 2011 to 2023, representing more than 18,000 individual patients. Among white patients, the percentage of people taking daily low-dose aspirin against recommendations fell by 8.3%, compared to just 0.2% among Black patients. Greater reductions were also seen among those on private insurance (9%) and on Medicare (7.5%), compared to those on Medicaid (2.4%) and the uninsured (1%).
"When it comes to medications, more is not always more," said Anderson, who is also a primary care physician at UPMC. "Clinicians are increasingly seeking to optimize medication usage by deprescribing medications with little proven benefit or elevated risks. It's important to know who those efforts are benefiting and who we need to work harder to reach."
Linnea M. Wilson, M.P.H., of Beth Israel Deaconess Medical Center was first author on the paper. This research was supported by the National Institute on Aging (K76AG074878).
