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Does an Aspirin a Day Keep Heart Disease Away?

Written by American Specialty Health | Sep 2, 2022 8:32:01 PM

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.

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:

  • If you’ve never had a heart attack or stroke and don’t have a high risk of having either one: The pros do not seem to outweigh the cons. Taking aspirin does not lower your risk of heart disease all that much. But it can raise your risk of bleeding. So, your doctor may not recommend it for you.
  • If you have never had a heart attack or a stroke, but you do have risk factors for heart disease: You’re in more of a grey area. If you’re not at a high risk for bleeding, you might want to take a daily aspirin. It may help offset some of those risk factors for heart disease. But it’s really up to you and your doctor to decide.
  • If you have had a heart attack or a stroke: The pros do seem to outweigh the cons. Reducing the risk of another heart attack or stroke is vital. So, experts might still recommend a daily low-dose aspirin in those cases, along with any other treatments. There’s still a risk of bleeding. But that's less a threat to your overall health than a heart attack or stroke.

For adults who are 60 years old and older:

  • If you do not have heart disease: Do not start daily low-dose aspirin. It does not seem to lower your risk of a first heart attack or stroke that greatly. But it can raise your risk of bleeding quite a bit.
  • If you have heart disease and/or have had a heart attack or stroke: Start or continue taking low-dose aspirin if your doctor recommends it.

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:

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.

 

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