Should I Take Aspirin? Does an Aspirin a Day Keep the Doctor Away?
Q. Should I take Aspirin to prevent heart disease and stroke if I have never had a heart attack or stroke in the past?
A. Aspirin (also known as ASA or acetylsalicylic acid) has proven itself as valuable weapon against heart disease and stroke in people who have these conditions. Patients who have had a heart attack, angina, ischemic stroke (one caused by a blood clot), or TIA (transient ischemic attack) have benefited from the use of daily Aspirin. By virtue of its anti-platelet activity (makes blood less “sticky”), this little pill has reduced the re-occurrence of these nasty cardiovascular events in these patients. It has even been shown to reduce the risk of death in this group of at-risk patients.
But that’s treating patients who already have cardiovascular disease (called “secondary prevention”). But what if you have never had any such event but you want to reduce the risk of heart attack or stroke? (”primary prevention”). Suprisingly, this is not an easy question to answer.
Studies have shown that patients who have never had cardiovascular disease may benefit, to a lesser extent, from daily Aspirin usage. But, the problem is, the potential benefit of Aspirin needs to be balanced against the risk of side effects from this drug. The biggest side effect of concern is bleeding. The most worrisome bleeding events from Aspirin are stomach or intestinal bleeds, and even worse brain bleeds (hemorrhagic stroke). Although the risk of these side effects is low (about 1 in 200 patients for stomach bleeds and 1/800 for hemorrhagic stroke), so is the potential benefit from Aspirin (less than 1/100).
It appears that patients who have 1 or more risk factors for cardiovascular disease, and are over the age of 50, may derive benefit from Aspirin that outweigh any of its potential risks. Risk factors for cardiovascular disease include: diabetes, high blood pressure, family history of heart disease, smoking, high cholesterol and obesity. To find our what your risk of cardiovascular disease is, take a CHD risk calculator test:
Risk Calculator for Americans
Risk Calculator for Patients in Canada and Internationally
If you have difficulty completing the tool, ask your doctor or pharmacist for more information.
If you scored a 10-year risk of at least 10%, Aspirin may be beneficial for you.
If you now think that Aspirin might be right for you, talk to your doctor or pharmacist. Low dose Aspirin, 75 to 100 mg, keeps the risk of bleeding low, while maintaining its effectiveness at preventing blood clots that cause heart attacks and strokes. But, because it can cause bleeding, Aspirin should be avoided in patients who have had recent bleeding problems or who are at risk for bleeding. If your blood pressure is not controlled, this can also increase your risk of hemorrhagic strokes. So you should ensure that your medical team has your blood pressure under control before considering starting ASA. You should also talk to your doctor or pharmacist if you have had an allergy to aspirin or any anti-inflammatory drug (NSAID) in the past.
In summary, if you have had a heart attack or stroke, Aspirin can be very beneficial. If you are in this group and you are not taking Aspirin, talk to your doctor or pharmacist. However, the risks and benefits of Aspirin in those who do not have cardiovascular disease must be weighed more closely. If you are older than 50 years old and have at least one cardiovascular disease risk factor, or have an estimate 10-year risk of coronary heart disease at least 10%, Aspirin may be beneficial for you.
For more information about whether you should take Aspirin... Ask Your Pharmacist!
