i have been asked a lot lately about the recent draft recommendation from the united states preventive services task force that adults over 60 do not need to take a daily aspirin. while this might be surprising to some, it is actually based on nearly a decade of research and is not really news to most medical people. but, before people start throwing away their medication, we should remember that there is a difference between people who are trying to prevent a heart attack and those who have already had one.
but many of the people taking aspirin do not have prior cardiovascular disease. these primary prevention patients were probably told to start aspirin at some point or might have even started it themselves because of the often repeated maxim that everyone over the age of 50 should take a daily aspirin. in the past, some studies did suggest a benefit for a baby aspirin once a day. studies like the physicians’ health study and the hypertension optimal treatment trial showed a benefit to daily aspirin and are likely responsible for the common perception that people, especially those with risk factors, should be taking it for primary prevention.
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but the reality is that these studies are decades old and the evidence base has not held up over time. more contemporary studies have not shown a benefit to daily aspirin for primary prevention, and a 2009 meta-analysis by the antithrombotic trialists collaboration as well as a more recent 2019 meta-analysis in jama both showed the benefit to aspirin therapy was minimal and largely offset by the increased risk of bleeding.
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