From the Guidelines
For a 58-year-old who started low-dose aspirin for primary prevention of cardiovascular disease (CVD), they should continue taking it beyond age 60 and complete the full 10-year course if they remain at average bleeding risk. The recommended approach is to maintain the daily low-dose aspirin (typically 81-100 mg) for the entire intended duration of therapy, as supported by the U.S. Preventive Services Task Force recommendation statement 1. Stopping at age 60 without completing the planned 10-year course could reduce the preventive benefits that accumulate over time. The decision to continue aspirin should be reassessed periodically, considering any changes in bleeding risk factors such as development of gastrointestinal conditions, use of other anticoagulants, or significant changes in kidney function.
Key Considerations
- The U.S. Preventive Services Task Force recommends that adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should consider taking low-dose aspirin daily for at least 10 years, provided they are not at increased risk for bleeding and have a life expectancy of at least 10 years 1.
- The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD in adults younger than 50 years or 70 years or older 1.
- The American College of Chest Physicians also suggests low-dose aspirin (75-100 mg/d) for primary prevention of cardiovascular disease in patients aged 50 years or older, but this guideline is less recent than the USPSTF recommendation 1.
Clinical Implications
The rationale for continuing aspirin beyond age 60 is that the cardiovascular protective effects of aspirin in primary prevention are cumulative over time, with benefits potentially outweighing risks when used for the full intended duration in appropriately selected patients. If bleeding risk increases substantially during the treatment period, the risk-benefit balance should be reconsidered with a healthcare provider.
From the FDA Drug Label
The chance is higher if you are age 60 or older The FDA drug label does not answer the question.
From the Research
Aspirin Use for Primary Prevention of CVD
- The use of low-dose aspirin for primary prevention of cardiovascular disease (CVD) is a topic of ongoing debate, with recent guidelines and studies providing evidence-based recommendations 2, 3.
- For adults aged 40-59 years with a 10% or greater 10-year CVD risk, the US Preventive Services Task Force (USPSTF) concludes that aspirin use has a small net benefit, and the decision to initiate low-dose aspirin should be individualized 2.
- However, for adults 60 years or older, the USPSTF recommends against initiating low-dose aspirin for primary prevention of CVD, citing no net benefit 2, 3.
Considerations for Continuing Aspirin Use
- If a 58-year-old is started on low-dose aspirin for primary prevention of CVD, the decision to continue or stop aspirin use at 60 years old should be based on individual risk factors and bleeding risk 2, 4.
- Patients who are not at increased risk for bleeding and are willing to take low-dose aspirin daily may be more likely to benefit from continued use 2.
- Advanced subclinical atherosclerosis, underlying conditions, and other risk factors should be considered when evaluating the risk-benefit ratio of aspirin use in individual patients 4.
Bleeding Risk and Aspirin Use
- The risk of major bleeding, including gastrointestinal bleeding and hemorrhagic stroke, is a significant consideration when evaluating the use of aspirin for primary prevention of CVD 5, 2.
- Patients with a history of gastrointestinal ulcers, recent bleeding, or other medical conditions that increase bleeding risk should be carefully evaluated before initiating or continuing aspirin use 2, 3.