Upgrade: Millions of older Americans may be using this over-the-counter medication wrong

The guidelines for taking aspirin to prevent heart disease have changed.

But many Americans don’t seem to realize that. Indeed, according to a new study of more than 14,000 adults published Monday in the Annals of Internal Medicine: “Aspirin use in the United States is widespread among groups at risk for harm.”

The study by researchers from Beth Israel Deaconess Medical Center found that about 29 million U.S. adults aged 40 and older without cardiovascular disease use aspirin daily to prevent cardiovascular disease, with about 6.6 million taking it even though their doctor had not prescribed it to them. What’s more, nearly half of people over 70 without cardiovascular disease — an estimated nearly 10 million people — take low-dose aspirin each day.

This is problematic because guidelines released in 2019 from the American College of Cardiology and the American Heart Association, based on multiple studies, now say that “low-dose aspirin ‘should rarely be used’ to prevent heart attacks and stroke in people over 70 or without known cardiovascular disease,” as MarketWatch reported earlier this year. The reason: multiple studies showed that the risks of taking aspirin, like internal bleeding, may outweigh the benefits in these groups.

Who should avoid taking daily aspirin? For years, even adults without cardiovascular disease were told to take a daily low-dose aspirin (typically 81 mg, whereas a regular dose is usually 325 mg); the new thinking is that most adults without cardiovascular disease don’t need daily aspirin. Plus, the American College of Cardiology now says that it is “important” for most people with the following conditions to avoid taking daily aspirin: increased risk of bleeding including GI bleeding or peptic ulcer disease, and those with thrombocytopenia, coagulopathy, chronic kidney disease, and a few other conditions outlined here. However, if you’re taking it and fall into one of these categories, ask your doctor before stopping medication.

Who should take daily aspirin? If you’ve already had a heart attack or a stroke or a bypass procedure, have a stent, or have been diagnosed with cardiovascular disease, and your doctor says you should take daily low-dose aspirin, continue to do so, according to the American Heart Association. If you fall into one of these categories and don’t take daily aspirin, it’s important to consult with a doctor before you begin taking it.

Aspirin makers Bayer, Bufferin and Ecotrin have not yet responded to request for comment about this study. But when the revised aspirin guidelines came out earlier this year, as MarketWatch reported, Bayer wrote this on its website: “Aspirin continues to be the cornerstone treatment for the prevention of secondary cardiovascular events (secondary prevention) … Aspirin is widely recognized as one of the pre-eminent antiplatelet therapies of choice across a wide cardiovascular risk continuum, based on its proven efficacy, safety and cost-effectiveness.”

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