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Aspirin for Prevention: Yes or No?

April 24, 2014

by Cardiologist Adam Kunin, MD

Let’s imagine a conversation with a patient and her doctor:

Patient:”Doc, should I start taking an aspirin a day to prevent a heart attack or stroke?

Doctor: “Well, let’s sit down and talk about it…”

Why can’t the doctor come up with a simple one-sentence answer? What makes this so complicated? The reason is that aspirin is a powerful drug which has competing effects on the human body, some good and some bad. We like aspirin’s ability to prevent blood clots in places they are not wanted, such as the heart and the brain. What we don’t like is that same blood-thinning ability when it increases the chances of a bleeding problem, such as a bleeding ulcer.

A Little History
Aspirin is one of the oldest medicines in continuous human use. It dates back 3,500 years ago, where it is mentioned both by the ancient Greek physician Hippocrates and in Egyptian medical texts. Back then it was known as an extract of bark from the Willow tree. Bayer began selling the purified form, acetylsalicylic acid, in 1897.

The Good
In both men and women who have already had an event such as a heart attack, cardiac stent or bypass surgery, aspirin has been shown to decrease the chance of the next event. We know that taking it away, even for a short time such as for minor surgery, can increase the chance of a heart attack.

We also know that treating a heart attack, or even a suspected one, with a full adult aspirin can start to break up the clot and make the heart attack smaller. That is the science behind the famous advertisements you have seen on TV.

On the other hand, trying to prevent a first heart attack with aspirin has a much smaller effect. It seems to reduce the chances of a first heart attack for men ages 45-79 by a modest 20%. For reasons that are not clear, the Women’s Health Study showed no significant heart attack benefit for women. Women ages 55-79, as well as men, do gain a small benefit in stroke reduction.

The Bad
If you have ever had a bleeding ulcer, or similar bleeding problem, then you probably known that aspirin, along with a long list of other medications such as Motrin, Advil, and various other “blood thinners,” will contribute to the chance of bleeding. That is the Achilles Heel of aspirin. The good news is that if you only take a baby aspirin a day, 81 mg, the bleeding risk is lower.

The Bottom Line
Let’s go back to our imaginary conversation. Where do we go from here? The U.S. Preventive Services Task Force recommends the following:

A baby aspirin daily for men ages 45-79, for heart attack prevention when the benefit of preventing a heart attack outweighs the risk of causing a bleeding problem.

A baby aspirin daily for women ages 55-79, for stroke prevention when the benefit of preventing a stroke outweighs the risk of causing a bleeding problem.

Sound vague? It is. What is perfectly clear is that both men and women should talk with their doctor first before taking baby aspirin daily to avoid a heart attack or stroke. You and your medical provider need to weigh the pros and cons based on your individual circumstances. There is no magic pill to prevent heart attacks or strokes; it involves a holistic comprehensive perspective. Working with your doctor, you will find what works best for you.