USA: People aged 60 or older who do not already have heart disease should not start taking aspirin, according to the US Preventive Services Task Force (USPSTF). With an update to its 2016 recommendation, the USPSTF has finalized its tougher stance on aspirin use for the primary prevention of cardiovascular disease.
Additionally, the recommendation statement, published in the Journal of the American Medical Association states that the decision to initiate aspirin in those between 40 and 59 should be made on a patient-to-patient basis and only if their individual 10-year risk of CVD is 10% or higher.

For updating its previous recommendations, the USPSTF commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (stroke and myocardial infarction), cardiovascular mortality, and all-cause mortality in people without a history of CVD. The systematic review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use. Also, the USPSTF commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use for primary prevention of CVD and CRC, stratified by age, sex, and CVD risk level.
"The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit," the take force wrote in their statement. "The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit."
Recommendations include:
The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one.
Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. (C recommendation)
The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. (D recommendation)
Reference:
US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577–1584. doi:10.1001/jama.2022.4983