Should Healthy People Over 60 Take Aspirin or Statins to Prevent Heart Attack or Stroke?

As people grow older, concerns about preventing heart disease and stroke often increase. Even those who feel perfectly healthy and have never experienced a heart attack or stroke may wonder whether taking a daily medication could help reduce their risk in the long run. A similar query was posted on Quora: Should a person over 60 take aspirin and statins to lower their risk of heart attack, stroke, and possibly prolong their life, even if they are considered healthy by a doctor? We decided to get an expert’s view on whether a healthy person over 60 should take aspirin or statins to prevent a first heart attack or stroke. DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine. “Being over 60 does not automatically mean you need aspirin or a statin. These medicines are prescribed based on a person’s overall cardiovascular risk, not age alone,” Dr Aseem Dhall, Director & HOD, Cardiac Sciences, ISIC Multispeciality Hospital tells indianexpress.com. If a person has never had a heart attack or stroke, aspirin is generally not routinely started simply for prevention after the age of 60. “Statins, however, may be appropriate for some people without previous cardiovascular disease if their estimated risk is high enough,” he adds. Doctors therefore look at an individual’s risk factors rather than prescribing either medicine simply because someone has crossed a particular age. “Doctors look at the overall risk of developing cardiovascular disease, rather than cholesterol in isolation,” says Dr Dhall. This assessment can include blood pressure, diabetes, smoking, kidney disease, family history of early heart disease, triglycerides, and other lipid measurements. “Newer guidelines also recommend considering lipoprotein(a), and sometimes apolipoprotein B, to better understand risk.” For some people, additional testing can provide more information. “For some people, a coronary artery calcium scan can provide additional information about plaque in the arteries,” Dr Dhall explains. In older adults, the decision also goes beyond cardiovascular risk numbers—doctors also consider “overall health, frailty, other medicines, life expectancy and personal preferences.” Dr Dhall explains that aspirin can reduce clot formation because it makes blood platelets less likely to stick together. But that same action can also increase bleeding risk. In older adults, this becomes particularly important when aspirin is being considered for someone who has never had a cardiovascular event. “Daily aspirin can increase the risk of gastrointestinal bleeding, bleeding inside the brain and haemorrhagic stroke,” the cardiologist cautions. The risk may be higher in old age and among people who have previously had ulcers or bleeding problems, or who take certain medicines. This is why aspirin is no longer routinely recommended for starting primary prevention after 60. “It should only be taken when a doctor identifies a clear reason,” he adds. “Primary prevention means preventing a first heart attack or stroke in someone who has not previously had cardiovascular disease,” says Dr Dhall. In this situation, aspirin may not offer enough benefit to justify its bleeding risk. “Here, the potential benefit of aspirin may be small and can be outweighed by bleeding risk,” he says. “Secondary prevention means preventing another event after a person has already had a heart attack, stroke or established cardiovascular disease,” he explains. The treatment approach can therefore be different for someone who already has cardiovascular disease. “In these patients, medicines such as statins and, when appropriate, antiplatelet treatment can have a much clearer role,” says Dr Dhall. Treatment should still be individualised according to the person’s medical history and overall health. For an older adult who wants to reduce their risk of heart attack and stroke, medication is only one part of prevention. “The foundation of cardiovascular prevention is not a pill,” says Dr Dhall. He recommends regular physical activity, a heart-healthy diet, maintaining a healthy weight, controlling blood pressure and blood sugar, avoiding tobacco, getting adequate sleep, and attending regular health check-ups. “Cholesterol should also be monitored and treated when the overall risk indicates a benefit,” he adds. For older adults, doctors should consider functional health, other medical conditions, medicines and life expectancy when deciding whether preventive treatment is appropriate. “The goal is to reduce cardiovascular risk while preserving independence and quality of life,” the cardiologist concludes. DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.