Daily use of aspirin carries risks. Many older adults take it anyway.

New research shows that as many as 18.5 million older adults regularly take aspirin to prevent heart disease, even though the risks of the drug outweigh the benefits for many of these patients.

The new studypublished Monday in the journal Annals of Internal Medicine, examined self-reported data from more than 186,000 adults in the United States and found that nearly a third of people age 60 or older without cardiovascular disease used aspirin in 2021. generally not recommended for these patients, largely because it increases the risk of gastrointestinal bleeding.

“Some of this use is potentially harmful because it may cause more bleeding than it provides cardiovascular protection, especially in these older adults,” said Dr. Mohak Gupta, one of the study authors and a senior resident at the Cleveland Clinic.

Dr. Valentin Fuster, president of Mount Sinai Fuster Heart Hospital and former president of the American Heart Association, said he was concerned that so many patients who do not benefit from aspirin are still using it, and that in many cases doctors seem to have advised these patients to use the drug.

“It’s not really the patients who get in their own way,” said Dr. Fuster, who was not involved in the investigation. (However, the study did find that doctors recommended the drug less often in 2021 than in previous years.)

Aspirin works by thinning the blood, lowering the risk of blood clots that can clog the arteries and lead to a heart attack or stroke. For years, doctors recommended taking low-dose aspirin to prevent heart disease.

But that practice began to shift in recent years. In 2019, the American Heart Association and the American College of Cardiology published guidelines suggesting that blood thinners should not be used routinely to prevent cardiovascular problems in adults over 70. And in 2022, the U.S. Preventive Services Task Force recommended for people aged 60 years or older with no history of cardiovascular problems who take aspirin to prevent heart disease.

Doctors warn against its use in these patients because of the risk of gastrointestinal bleeding. According to Dr. Gupta, this risk is greatest in people aged 60 and over or in people who are already at risk of gastrointestinal bleeding.

Certain groups of patients may still benefit from daily aspirin, including those who have had a previous heart attack or stroke or have been diagnosed with heart disease, Dr. Gupta said. In these cases, the drug can prevent heart problems from returning or getting worse, he added.

The drug could also be suitable for people aged 40 to 59 who have no history of bleeding but are at higher risk of cardiovascular disease due to obesity, high blood pressure, high cholesterol, smoking or other risk factors, said Dr . Gupta.

Even though aspirin is available without a prescription, its risks mean patients should always consult their doctor before using the medication, said Dr. Gupta. “This is a decision that should not be made by the patients themselves,” he said.

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