Low-Dose Aspirin May Not Help People Live Longer
Since the mid-1970s, low-dose aspirin has been promoted as a way to prevent heart attacks and strokes. Companies that make aspirin often show a heart on the label, so you make the connection between protecting your heart and taking a daily aspirin. To expand aspirin use to more people, drug companies lobbied the Food and Drug Administration (FDA) to allow aspirin to be marketed to anyone with a coronary risk factor.
It took over 10 years, but on May 2nd, 2014, the FDA responded to the drug companies request. The FDA said it had, "reviewed the available data and does not believe the evidence supports the general use of aspirin for primary prevention of a heart attack or stroke. In fact, there are serious risks associated with the use of aspirin, including increased risk of bleeding in the stomach and brain."
In other words, for people who have NOT already had a heart attack or stroke, the risk of bleeding in the stomach or brain was greater than the preventative benefits of aspirin. A low dose aspirin is only a good idea AFTER you've already suffered an attack.
Even after that decision was announced, people around the world continued to take a daily low-dose aspirin, in the belief that it might help them live longer. Even people who had never suffered a heart attack or stroke. At least one large clinical trial has now proven that belief was wrong.
Over 19,000 people in the United States and Australia were enrolled in a study that began in 2010. To be included, you could not have cardiovascular disease, dementia or a physical disability. About half of the people were given 100mg of a low-dose aspirin and the rest were given a placebo. Results were tracked over a period of approximately five years.
The researchers found that people taking low-dose aspirin had no more protection from heart attacks or strokes than the people taking a placebo. In fact, the people taking aspirin increased their risks of bleeding and a major hemorrhage. At the end of the trial, more deaths were attributed to bleeding from aspirin use, than were saved. Researchers warned that excessive aspirin use was leading to around 3,000 preventable deaths a year.
According to the findings of 13 studies involving 164,000 people, aspirin can reduce the risk of cardiovascular problems by 11 percent. However, taking aspirin increases the risk of a significant bleeding event by 43 percent. The key is prescribing aspirin appropriately.
As a result of all these studies, the American College of Cardiology and the American Heart Association released new guidelines. They say that low-dose aspirin should not be given as a routine preventive measure for adults 70 years and older, or for any adult that has an increased risk of bleeding. If you have no clinical signs of heart disease or stroke, it's probably best to avoid the pill.
For people who have had cardiovascular problems, the recommendations haven't changed. The benefits of a daily pill are greater, than tshe risk of a major bleeding problem.
A risky pill isn't the only option you have to live longer. If you're overweight, replace meat with vegetables to drop a few pounds. Quit drinking sugar-loaded beverages. If you smoke, quit. Get at least 30 minutes of cardio and weight training exercises a day. If you're sitting all day, stand up once in a while. Each of those options are more effective than aspirin, plus they help with dozens of other conditions as well.
Ultimately it's a discussion you need to have with your doctor. Together you can weigh the risks and benefits, to decide if you're a candidate for low-dose aspirin therapy. To help, researchers have a calculator that you can use to assess your personal risk level. It's called the, “Pooled Cohort Risk Assessment Equations.” You can find the risk calculator here: https://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx
Talk to your doctor so you can weigh the risks and benefits of low-dose aspirin therapy.
UPDATE 9/1/2025:
The Discovery: Researchers have found that clopidogrel, a blood-thinning medication, is more effective than aspirin at preventing heart attacks and strokes in people with coronary artery disease (CAD).
The Study: An international team analyzed data from nearly 29,000 patients across seven clinical trials. The results were presented at the European Society of Cardiology congress and published in The Lancet.
Key Findings:
- Patients taking clopidogrel had a 14% lower risk of major cardiovascular events (heart attack, stroke, or cardiovascular death) compared to those taking aspirin
- Importantly, clopidogrel didn't increase bleeding risks compared to aspirin - a major safety concern with blood thinners
- The benefits were consistent across different patient groups, even those who might genetically respond less well to clopidogrel
Why This Matters: For decades, aspirin has been the standard treatment for preventing cardiovascular events in the 300+ million people worldwide with CAD (including 2.3 million in the UK). This research suggests clopidogrel should become the preferred choice instead.
Next Steps: The findings could lead to changes in medical guidelines worldwide. Both drugs are widely available and affordable, making this shift potentially feasible globally. However, more research on cost-effectiveness and broader population studies will be needed.
This represents a significant potential shift in how doctors treat one of the world's most common and deadly heart conditions.
Reference Links:
Effect of Aspirin on Disability-free Survival in the Healthy Elderly
John J. McNeil, M.B., B.S., Ph.D., Robyn L. Woods, Ph.D., Mark R. Nelson, M.B., B.S., Ph.D., Christopher M. Reid, Ph.D., M.P.H., Brenda Kirpach, C.C.R.A., Rory Wolfe, Ph.D., Elsdon Storey, M.B., B.S., D.Phil., Raj C. Shah, M.D., Jessica E. Lockery, M.B., B.S., Andrew M. Tonkin, M.B., B.S., M.D., Anne B. Newman, M.D., M.P.H., Jeff D. Williamson, M.D., M.H.S., Karen L. Margolis, M.D., M.P.H., Michael E. Ernst, Pharm.D., Walter P. Abhayaratna, M.B., B.S., Ph.D., Nigel Stocks, M.B., B.S., M.D., Sharyn M. Fitzgerald, Ph.D., M.P.H., Suzanne G. Orchard, Ph.D., Ruth E. Trevaks, Ph.D., Lawrence J. Beilin, M.D., Geoffrey A. Donnan, M.B., B.S., M.D., Peter Gibbs, M.B., B.S., M.D., Colin I. Johnston, M.B., B.S., M.D., Joanne Ryan, Ph.D., M.Biostat., Barbara Radziszewska, Ph.D., M.P.H., Richard Grimm, M.D., Ph.D., M.P.H., and Anne M. Murray, M.D., for the ASPREE Investigator Group
The NEW ENGLAND JOURNAL of MEDICINE, Published September 16, 2018
Click Here for the Study: https://www.nejm.org/doi/full/10.1056/NEJMoa1800722
Clopidogrel versus aspirin for secondary prevention of coronary artery disease: a systematic review and individual patient data meta-analysis
Prof Marco Valgimigli, MDa,b, ∙ Prof Ki Hong Choi, MDc, ∙ Daniele Giacoppo, MDd,e,f ∙ Felice Gragnano, MDg ∙ Prof Takeshi Kimura, MDh ∙ Hirotoshi Watanabe, MDh ∙ Prof Hyo-Soo Kim, MDi ∙ Prof Jeehoon Kang, MDi ∙ Prof Kyung Woo Park, MDi ∙ Prof Alf-Åge Pettersen, MDj ∙ Prof Mark Woodward, MDk,l ∙ Prof Deepak L Bhatt, MDm ∙ Prof Paolo Calabrò, MDg ∙ Prof Dominick J Angiolillo, MDn ∙ Prof Roxana Mehran, MDm ∙ Prof Young Bin Song, MDc ∙ Prof Joo-Yong Hahn, MD
The Lancet Journal, Published Online first August 31, 2025
Click Here for the Study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01562-4/abstract
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7/27/2019
Update 9/1/2025
