An Aspirin a Day?

Today, we’ll talk about aspirin….and whether you might benefit from taking a daily aspirin tablet.

First, a little about aspirin itself. It’s complete name is acetylsalicylic acid, or ASA for short. It comes in a variety of sizes, but the most common are 81 mg (the “baby” aspirin) and 325 mg (the standard dose). Aspirin is used for a variety of purposes, including as an analgesic (pain reliever), an anti-pyretic (relieves fever), and as an anti-inflammatory medication. The main unwanted side effect of aspirin is a small risk of stomach bleeding.

Today, we’ll focus on the use of aspirin to prevent adverse events such as heart attack, stroke, or vascular disease.

Individuals who already have cardiovascular disease (CVD)

For people who already have cardiovascular disease (of almost any sort), aspirin has been shown in many studies (involving 10’s of thousands of patients) to reduce the chance of having heart attack, stroke, or new vascular disease. We call this “secondary prevention”–preventing a “second” problem. If you fit into this category, you should talk with your doctor about taking aspirin or other similar medication.

Individuals who DO NOT have cardiovascular disease (CVD)

For this group of people, recommendations about aspirin use are a little more complicated. We call this “primary prevention”–preventing the first episode of important CVD.

If we look at this entire group of healthy people, aspirin HAS NOT been shown convincingly to reduce the chances of developing important CVD, but…. It turns out that for SOME healthy people–those with a somewhat elevated risk (based on risk factors) of developing CVD at some point–aspirin actually does provide a benefit. So….the issue becomes sorting out which people benefit and which people do not.

This is where my previous Blog Post comes into play. You should use the worksheets and tables (separate worksheets and tables for men and women) to determine your 10-year risk of developing CVD. Many of you will find that that risk is nearly zero, but you’ll also see that the presence of any risk factor can elevate that risk substantially.

The American Heart Association recommends daily aspirin for patients whose 10-year risk of CVD is >=10%. That’s pretty easy. But there may be good reason to use daily aspirin even if your risk is less than that. A useful algorithm for making decisions about daily aspirin for primary prevention was published in the 2007 Guide to Clinical Preventive Services by the Agency for Healthcare Research and Quality (AHRQ):

“Men older than 40 years, postmenopausal women, and younger people with risk factors (eg, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to consider aspirin therapy.”

I believe this is a useful approach. If you are healthy and have ANY risk factor for CVD, you should discuss the potential benefits of daily aspirin therapy with your doctor.

How much aspirin?

It turns out that a daily baby aspirin (81 mg) is probably just as effective as the standard dose (325 mg)….and may reduce the chances of having stomach bleeding.

So, to summarize…. Daily aspirin use is effective for secondary prevention. It is also effective for primary prevention in some patients, particularly those with risk factors for CVD. It is wise to discuss the benefits and risks of aspirin with your doctor before starting this medication, though, because there is a very real risk of unwanted stomach (or other) bleeding. And lastly, a baby aspirin is probably the right dose for most people.

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    • Larry Creswell, MD says

      Like for patients with persistent atrial fibrillation, there can be a small risk of stroke in those with paroxysmal atrial fibrillation. If that risk is low, no medication may be necessary. If the risk is greater, aspirin or other anticoagulant may be appropriate.

      The issue is in predicting the risk of stroke. That risk is based on age, other heart conditions, etc. you can work with your doctor to use one of the available scoring systems to gauge your risk.

      Once you have your predicted risk of stroke, you can consider the pluses/minuses of the drugs to help reduce the risk.

      In the case of aspirin, the anti-stroke benefit must be weighed against the potential for unwanted bleeding problems.

  1. Rav says

    Hi Larry

    Could aspirin be the cause of hearing my heartbeat in my left ear? Started about 1 month after MI. I lost about 11kg too in that time too. It comes and goes but gets worse when I eat. Doctor says it’s nothing and offered me a hearing aid

    Thanks in advance

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