In 2019, the American College of Cardiology and the American Heart Association revised their recommendations on daily low-dose aspirin use.
Once widely believed to prevent heart attacks and strokes with minimal downsides, aspirin is now only recommended for adults under 70 at elevated risk for atherosclerotic cardiovascular disease, provided they have no significant bleeding risks.
However, new research published in JAMA reveals that these updated guidelines have not reached all segments of the population equally, leaving certain groups at higher risk of serious side effects.
The study, led by Dr. Timothy S. Anderson from the University of Pittsburgh, highlights that many individuals continue to take daily aspirin without clinical benefit. “Long-term aspirin use carries small but serious risks, including gastrointestinal bleeding and intracerebral hemorrhage,” said Anderson.
Efforts to reduce unnecessary aspirin use have seen uneven success, with some populations showing significantly less change than others.
Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), covering more than 18,000 adults aged 40 to 79 years from 2011 to 2023. Overall, the percentage of people using daily aspirin fell, but the decline was not uniform across demographic groups.
Among white patients, the prevalence of aspirin use dropped by 8.3%, compared to just 0.2% among Black patients. Similarly, reductions were larger for those with private insurance (9%) and Medicare (7.5%) compared to those on Medicaid (2.4%) or without insurance (1%).
This uneven decline suggests that public health messaging about the revised guidelines has not reached all communities effectively. Groups with lower reductions in aspirin use may remain at higher risk of bleeding complications, particularly as the risks of daily aspirin outweigh the benefits for many individuals not meeting the revised criteria.
Dr. Anderson emphasized the need for clinicians to tailor their efforts to ensure these updates reach all patients. “When it comes to medications, more is not always more,” he noted. “It’s crucial to deprescribe medications with little proven benefit or higher risks, but we need to ensure these efforts are equitable and benefit everyone.”
The study underscores the importance of improving communication and education about guideline changes, particularly for underserved populations. With disparities in health care access and awareness continuing to influence outcomes, targeted strategies are essential to reduce unnecessary aspirin use and prevent adverse effects in vulnerable groups.
In conclusion, while the shift in aspirin guidelines has led to positive changes overall, the uneven impact across racial, socioeconomic, and insurance groups highlights the need for more inclusive and effective outreach efforts.
Ensuring that all patients have access to updated, evidence-based recommendations will be critical to improving cardiovascular care and reducing risks associated with inappropriate medication use.
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The research findings can be found in JAMA.
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