Should I take a daily aspirin or not? We often talk about the ‘pendulum of medicine’. This refers to medical studies that for some time will promote or discourage something then later tell us to do the exact opposite. It’s a fact of life in medicine.
So aspirin…for years we have heard a daily aspirin is good for our hearts. But is it?
The Background on Aspirin
People have been using willow bark which contains a precursor medication similar to aspirin for at least 2,00 years. Aspirin is THE most widely used medicine in the world. In 2016, it was the 38th most prescribed medication in the United States. In addition, we estimate 6.6 million people are taking daily aspirin without a provider’s advice. Is it good for us? Do we need it? Who needs it?
The Research on Daily Aspirin Therapy
Last year 3 separate medical studies on aspirin came to the following conclusions:
The ASCEND trial
>15,000 participants, studied the effects of aspiring for diabetic patients for the prevention of heart disease. The benefit was NOT found to outweigh the bleeding risk.
https://www.nejm.org/doi/full/10.1056/NE JMoa1804988
The ARRIVE trial
Studied over 12,000 participants for 5 years. They found patients that had a moderate risk of heart disease did not receive benefit from aspirin therapy. They did not see a lot of adverse events –namely bleeding from patients either.
https://www.acc.org/latest-in-cardiology/clinical-trials/2018/08/25/01/46/arrive
The ASPREE trial
had 19,000 participants. They found higher all cause mortality in those over 70yrs on daily aspirin. This was an unexpected finding as about half of these deaths were attributable to cancer.
https://www.nejm.org/doi/full/10.1056/NEJMoa1803955
The Recommendations
The American College of Cardiology and the American Heart Association came out with new recommendations for aspirin use last year:
- Low-dose aspirin might be considered for primary prevention of heart disease in select higher risk adults aged 40-70 years who are not at increased bleeding risk.
- 81mg Aspirin (baby aspirin) should not be administered on a routine basis for primary prevention of heart disease among adults >70 years.
- Low-dose aspirin should not be administered for primary prevention among adults at any age who are at increased bleeding risk.
- They advise AGAINST aspirin therapy with a history of GI bleeding or peptic ulcer disease, bleeding from other sites, age >70 years, thrombocytopenia, coagulopathy, chronic kidney disease, and concurrent use of nonsteroidal anti-inflammatory drugs, steroids or anticoagulants.
Tips on Aspirin Use
- If you are taking aspirin –do not take with ibuprofen –this combination increases your bleeding risk 7x.
- Also, never give aspirin to children under 12 –due to the risk of Reye’s syndrome.
A final thought: my personal genetic testing tells me I have a 50% lifetime risk for developing blood clot. Airhealth.org notes that 3-5% of air travel passengers will develop a clot –while traveling. To prevent this, I do calf flexes, think about wearing compression socks, hydrate as well as I can. In addition, I also start 81mg aspirin therapy about a week before I am scheduled to fly to help further prevent blood clot. Is this right for everyone? No, but talk with your provider about whether this may be right for you too!
Want to check your personal risk of heart event in the next 10 years? Check out the American College of Cardiology Risk Estimator Tool link below:
http://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
***As with all guidelines and recommendations, medicine is not one size fits all. The decision to take aspirin therapy should be individualized and evaluated with your personal healthcare provider.***
Please note: Search engines penalize us if we quote our sources correctly. As a result, we use links like below so you can see our sources directly. Email me if you have more questions about a source.
https://en.wikipedia.org/wiki/Aspirin
I highly recommend this site.
Thanks Steve!