Daily Aspirin — Healthy or Harmful?

In decades past, a daily low-dose aspirin regimen was frequently recommended as a primary prevention strategy against heart disease. However, the evidence in support of it was rather weak, and kept getting weaker as time went on.

I stopped recommending daily “baby aspirin” use for the prevention of heart disease over two decades ago, due to the growing evidence of harmful side effects.

The primary justification for a daily aspirin regimen has been that it inhibits prostaglandin production,1 thereby decreasing your blood’s ability to form dangerous clots. However, in more recent years, most public health authorities have reversed their stance on the practice of using aspirin for primary prevention.
‘Baby’ Aspirin No Longer Recommended as Primary Prevention

The U.S. Food and Drug Administration reversed its position on daily low-dose aspirin as primary prevention for heart disease in 2014,2 citing clearly established side effects — including dangerous brain and stomach bleeding — and a lack of clear benefit for patients who have never had a heart attack, stroke or cardiovascular disease.
In 2019, the American Heart Association (AHA) and American College of Cardiology updated their clinical guidelines on the primary prevention of cardiovascular disease,3 spelling out many of the controversial findings on prophylactic aspirin use.
Importantly, studies have found that prophylactic aspirin use in adults over the age of 70 is potentially harmful, primarily due to the increased risk of bleeding in this age group. As noted in one 2009 paper,4 long-term low-dose aspirin therapy nearly doubles your risk for gastrointestinal bleeding.

Older people …
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