Does daily aspirin prevent heart attacks and strokes long-term?
Low-dose aspirin (75-100 mg daily) reduces risk of heart attacks and ischemic strokes by 20-25% in high-risk patients, such as those with prior cardiovascular events. Benefits persist over 5-10 years in secondary prevention but diminish in primary prevention for low-risk people, where absolute risk reduction is small (0.5-1% over 10 years). [1][2]
What bleeding risks come with long-term use?
Daily aspirin doubles the risk of gastrointestinal bleeding (2-4 extra cases per 1,000 users yearly) and increases intracranial hemorrhage by 50-100% (0.2-0.5 extra events per 1,000 users yearly). Risks rise with age over 60, concurrent NSAID/ anticoagulant use, or history of ulcers. Upper GI bleeds often require hospitalization; long-term users face 1.5-2x higher peptic ulcer risk. [1][3][4]
How does it affect kidneys and other organs over time?
Chronic use links to 20-30% higher chronic kidney disease progression risk, especially in those with baseline impairment or diabetes. It may worsen renal function via prostaglandin inhibition, with effects evident after 1-5 years. Rare long-term issues include tinnitus or hearing loss at higher doses (>325 mg). Liver effects are minimal. [2][5]
Are there cancer prevention benefits after years of use?
Aspirin cuts colorectal cancer risk by 20-40% after 10-20 years of daily use, per meta-analyses of trials like ASPREE and Women's Health Study. Benefits extend to other GI cancers but not lung or breast. Effect requires prolonged exposure; short-term use shows no gain. [1][6]
Who should avoid or stop long-term aspirin?
Guidelines (USPSTF 2022) advise against starting in adults 60+ for primary prevention due to bleeding outweighing benefits. Stop if active bleeding, uncontrolled hypertension, or nearing surgery. No clear upper age limit for secondary prevention, but reassess every 1-2 years. [2][7]
How do benefits and risks shift by age and dose?
Under 50: Benefits favor high-risk only; bleeding low. 50-59: Balanced for intermediate risk. 60+: Bleeding dominates unless prior events. Low-dose minimizes GI harm vs. 325 mg. Enteric-coated versions reduce but don't eliminate ulcers. [1][3]
[1] USPSTF Aspirin Use to Prevent CVD and CRC
[2] NEJM ASPREE Trial (2018)
[3] Lancet Meta-Analysis on Bleeding (2019)
[4] BMJ GI Bleeding Review (2020)
[5] JAMA Kidney Effects (2017)
[6] Annals of Oncology Cancer Meta-Analysis (2019)
[7] AHA/ACC Guidelines (2019)