You may have seen headlines recently about low-dose aspirin use. Read on to learn if an aspirin a day is still a good way to prevent heart disease.
For years, it was common for doctors to prescribe daily low-dose aspirin for adults, starting around age 50. After all, studies suggested that it might help lower the risk of heart attack and stroke. It seemed like good preventive care.
But the United States Preventive Services Task Force (USPSTF) made updates to their guidelines in April 2022. An aspirin a day does still seem to be beneficial for some people. But experts no longer recommend it for all adults.
To understand why, it’s helpful first to understand the pros and cons of aspirin.
The benefits of aspirin: Heart disease prevention
You may wonder why doctors ever prescribed aspirin—a pain reliever—to help prevent heart disease. Well, aspirin thins your blood and so helps prevent your blood from clotting. And this, in turn, can help prevent a heart attack or stroke.
If you get a blood clot in your arteries, it can block blood flow to your heart. And that can cause a heart attack. If you get a blood clot that blocks the flow of blood to your brain, that can cause a stroke.
By disrupting your blood’s ability to clot, aspirin may help prevent heart attacks and strokes.
The drawbacks of aspirin: Bleeding risks
That ability to reduce blood clots is both a blessing and a curse. Preventing clots that can block blood flow is a good thing. But if your blood doesn’t clot as well, then your body doesn’t have a good way to stop bleeding. That can be very dangerous.
Gastrointestinal bleeding is a particular concern. Aspirin interferes with your body’s ability to maintain the protective lining that coats the inside of your stomach and intestines. That means the harsh acid in your stomach may damage your stomach and intestines. Along with nausea and stomach ulcers, it can cause bleeding.
Brain bleeds are also a big concern. Studies have found that taking aspirin increases the risk of bleeding in the brain.
Internal bleeding of any kind is serious. Because there aren’t any noticeable signs, you may not be aware that you are bleeding for quite some time. It may cause a lot of harm. It may even be fatal. This is a particular risk with brain bleeds.
Weighing the pros and the cons of daily aspirin
To help weigh the pros and the cons, the USPSTF turned to the research. What it found is that the pros and cons weren’t the same for everyone. It depends on a number of factors, namely:
- Your age. As you get older, your risk of heart disease increases, but so does your risk of bleeding.
- Your risk of heart disease. If you smoke, or have high blood pressure, high cholesterol, or diabetes, those factors can raise your risk of heart disease. If you have a family history of heart disease, that can also raise your risk.
- A personal history of heart disease. Heart disease can include atrial fibrillation or a previous stroke or heart attack.
- Your risk of bleeding. If you have an ulcer or liver disease, that can raise your risk of bleeding. So can some medicines, like blood thinners, steroids, and other nonsteroidal anti-inflammatory drugs (NSAIDs). And if you smoke or have diabetes or high blood pressure, that can also raise your risk.
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The new guidelines for aspirin use Here are the USPSTF's updated recommendations: For adults who are between the ages of 40 and 59 years:
For adults who are 60 years old and older:
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Is a daily low-dose aspirin right for you?
If you have any questions about these new guidelines, talk with your doctor. You can discuss your history of or risk factors for heart disease, as well as any risks you might have for bleeding. Along with your age, that can help you and your doctor decide whether a daily aspirin might be right for you. Make sure, as well, to always talk with your doctor first before starting any new medication or making changes to your existing medication regimen.
If you and your doctor do decide that taking aspirin is right for you, the USPSTF recommends a dose of 81 milligrams per day. But check with your doctor to be sure.
You’ll also want to be open with your doctor about your alcohol use. Mixing alcohol with any type of medicine can be risky. This is true even when it comes to a seemingly safe over-the-counter pain reliever like aspirin. Alcohol can irritate the lining of your stomach. And, as you know, so can aspirin. When you combine the two, you can worsen that irritation. And that can raise your risk of ulcers and gastrointestinal bleeding.
Whatever you decide about aspirin, keep in mind that it is not a magic pill for preventing heart disease. It is one useful tool that can help certain people modestly lower their risk of a heart attack or stroke. But there are other, better tools that can help you reduce your risk of heart disease. Here are a few:
- Quit smoking.
- Eat healthy foods.
- Stay active.
- Watch your weight.
- Manage stress.
- Get regular health screenings.
These healthy lifestyle habits come with no risky side effects. They are some of the best ways to care, not just for your heart, but your whole body. So, even if your doctor does recommend that you take a daily aspirin, be sure to support your heart health by practicing these and other healthy habits.
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This information is not intended to take the place of regular medical care or advice. Please check with your doctor before using this information or beginning any self-care program. Images used for this article do not depict any members of the Silver&Fit Program.
References
American Addiction Centers. (2021, October 29). Is it safe to mix NSAIDs with alcohol? https://alcohol.org/mixing-with/nonsteroidal-anti-inflammatory/
American Heart Association. (2022, April 26). New USPSTF guidance: Continue to take low-dose aspirin if you have a history of heart attack, AFib, stroke, or vascular stenting. https://newsroom.heart.org/news/new-uspstf-guidance-continue-to-take-low-dose-aspirin-if-you-have-a-history-of-heart-attack-afib-stroke-or-vascular-stenting
American Society of Hematology. (n.d.). Blood clots. https://www.hematology.org/education/patients/blood-clots#:~:text=Clots%20can%20occur%20in%20veins,and%20back%20to%20the%20heart
Harvard Health Publishing. (2014, January 1). Answers about aspirin. https://www.health.harvard.edu/heart-health/answers-about-aspirin#:~:text=In%20addition%20to%20lowering%20the,stomach%20and%20intestines%20can%20occur
Harvard T. H. Chan School of Public Health. (n.d.). Preventing heart disease. https://www.hsph.harvard.edu/nutritionsource/disease-prevention/cardiovascular-disease/preventing-cvd/#:~:text=Primary%20prevention%20is%20usually%20aimed,%2C%20if%20needed%2C%20taking%20medications
Huang, W. Y., Saver, J. L., Wu, Y. L., Lin, C. J., Lee, M., & Ovbiagele, B. (2019, August 1). Frequency of intracranial hemorrhage with low-dose aspirin in individuals without symptomatic cardiovascular disease: A systematic review and meta-analysis. JAMA Neurology, 76(8), 906-914. https://doi.org/10.1001/jamaneurol.2019.1120
Mayo Clinic. (2021, October 15). Daily aspirin therapy: Understand the benefits and risks. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797#:~:text=Aspirin%20interferes%20with%20the%20blood's,blood%20vessel%2C%20stopping%20the%20bleeding
Mayo Clinic. (2022, January 14). Strategies to prevent heart disease. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502
MedlinePlus. (2021, May 15). Aspirin. https://medlineplus.gov/druginfo/meds/a682878.html
MedlinePlus. (2022, January 31). Blood thinners. https://medlineplus.gov/bloodthinners.html
United States Food and Drug Administration. (2016, February 22). Before using aspirin to lower your risk of heart attack or stroke, what you should know. https://www.fda.gov/drugs/safe-daily-use-aspirin/using-aspirin-lower-your-risk-heart-attack-or-stroke-what-you-should-know
United States Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Chelmow, D., Coker, T. R., Davis, E. M., Donahue, K. E., Jaen, C. R., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Stevermer, J., Tseng, C. W., & Wong, J. B. (2022, Apr 26). Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA, 327(16), 1577-1584. https://doi.org/10.1001/jama.2022.4983
This article was written by Nora Byrne, edited by Gail Olson, and clinically reviewed by Rebecca Potter, PharmD.
