The Lowdown on Low-Dose Aspirin for Primary Prevention

It’s hard to turn around a medical myth, exemplified by the notion that low-dose aspirin is safe and effective in healthy adults for primary prevention of heart disease, especially in people aged 60 years and older. In 2018, 3 pivotal, very large randomized trials were published, consistently showing the risk of major bleeding exceeded the benefit of CV event reduction. Even though it has now been >7 years since these trials were published, a substantial proportion of people of advanced age are still taking low-dose aspirin for primary prevention, mostly as advised by their physicians! In a survey of 160,000 Americans without heart disease, more than 30% of people age 70+ years were taking low-dose aspirin in 2021.

In this post, I’ll review the relevant data for low-dose aspirin, including some nuances, the guidelines, longer follow-up, and the question of use for cancer prevention.

The Lowdown on Low-Dose Aspirin for Primary Prevention