Doctor: Daily aspirin no longer recommended for all adults over 40

SAVANNAH, Ga. (WTOC) - The longstanding guidance for adults over 40 to take a daily aspirin for cardiovascular health is shifting, with doctors warning that gastrointestinal risks often outweigh the benefits for healthy individuals.

Cardiologist Dr. Roy Flood discussed the changing guidelines during an appearance on “Welcome to Our Community,” noting that daily aspirin use is no longer a blanket recommendation.

Recommendations shift to individual risk

Flood said aspirin was historically recommended as a broad preventive measure once adults turned 40, and slightly later for women, to reduce cardiovascular risk.

Over the past 15 to 20 years, however, medical studies revealed that long-term daily aspirin use carried significant side effects.

“Even though you may have fewer cardiac issues, the price is paid with more GI bleeding — gastrointestinal bleeding — stomach problems, etc.,” Flood said.

That tradeoff prompted the medical community to move away from universal guidance and tailor decisions to individual patient risk.

Risk factors determine aspirin use

Flood said patients with diabetes, hypertension, smoking history or a strong family history of cardiac disease remain good candidates for daily aspirin.

Aspirin serves as an anti-inflammatory and anti-clotting agent that helps prevent sudden artery blockages caused by plaque rupture — a primary trigger for heart attacks.

“Aspirin helps to reduce that, mitigate that risk and keep blood flowing through,” Flood said.

Conversely, a healthy 45-year-old with no underlying risk factors would likely not receive a prescription. Patients with existing bleeding disorders or gastrointestinal ulcers are also advised against regular use.

“It’s kind of a risk-benefits profile,” Flood said. “If the risk of bleeding is going to be higher than your cardiac risk, we need to hold off on the aspirin.”

Calcium scoring aids evaluation

To determine individual risk before symptoms appear, physicians often use a coronary artery calcium score to check for early plaque buildup.

Flood said an elevated score can prompt doctors to start aspirin therapy even if a patient shows no outward warning signs.

“If your calcium score is perfect and you’re not having symptoms, and other risk factors are under control, you don’t need the aspirin,” Flood said. “And I think that’s the takeaway point.”