Risks and Benefits of Daily Aspirin for Heart

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January 26, 2015 (Updated: August 16, 2018)
Lily Moran

In the beginning (c. 1980s), it was a matter of simple cause and effect logic.  Study after study proved that the humble aspirin worked lifesaving wonders:

  • Heart attacks and many strokes are caused by blood clots.
  • Aspirin prevents clots from forming by thinning the blood.
  • Therefore, aspirin prevents heart attacks and many strokes.

Such a simple solution to such a deadly problem was an immensely appealing proposition.  Doctors everywhere began prescribing daily aspirin for almost every patient, and taking it themselves.

As the practice took off, of course, new questions arose with it.  The most important at the time concerned dosage.  The regular adult dosage was 325 mg. Over time, tests confirmed that as little as an 81 mg “baby aspirin” provided sufficient, proven clot prevention.

That was the conventional wisdom until recently.

Daily Aspirin Is Not For Everyone

A recent, rigorous, and robust study of 100,000 people over 6 years has overturned the conventional wisdom.

Conclusion #1: It turns out that, aspirin isn’t all that effective as a preventive.  Total cardiovascular events among the study’s 100,000 research subjects decreased by just 10 percent. And while that may sound substantial, it doesn’t mean that where 10 out of 100 people would have gotten a heart attack, now zero will. It means that if you had a 5% risk of having a heart attack this year, taking aspirin every day would change that to a 4.5% risk.

Conclusion #2: Daily aspirin can increase the likelihood of stomach bleeding—a serious issue I raised in an earlier e-letter. Results linked daily aspirin therapy with a 30 percent increased risk for intestinal bleeding.

Daily aspirin lowers one area of risk a little bit and raises another area of risk. If you aren’t at high risk for a heart attack or stroke, it doesn’t make sense for you to increase your risk of stomach bleeding. But what’s the best way to determine if daily aspirin is for you?

It’s Time To Re-Examine Who Needs Daily Aspirin

Here’s what the data tell us.

Though aspirin can prevent clots from forming, it doesn’t change the underlying cause of heart disease and clot-related stroke: atherosclerotic plaque.

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Chronic Inflammation Decoded

So it’s best to rely on the tried and true ways of preventing plaque in the first place—proper diet and exercise, maintaining a healthy weight, antioxidants and natural anti-inflammatories, low blood pressure, and stress reduction.

That said, aspirin can be the difference between life and death if you’ve already had a heart attack or clot-related stroke, if you have heart disease, a history of angina, or have had angioplasty, stent procedures, or coronary artery bypass surgery. 

If any of the above applies to you, I do suggest you take a daily aspirin in the 81 mg dosage—with one important exception (which I’ll get to shortly).

But if none of the above applies to you, I recommend against taking aspirin as a preventive.  The risks simply outweigh the benefits for you because it could cause dangerous intestinal bleeding.

You Should Take 81 Mg Daily Unless …

There’s a chance you are “aspirin resistant.”  That means just what it says—when it comes to preventing blood clots, aspirin simply doesn’t work for you.

We don’t yet know the cause of this resistance.  But research cited by The American Heart Association suggests that as few as 5 percent and as many as 45 percent of the population might be affected.

If your cardiovascular or stroke history makes you a candidate for daily aspirin therapy, knowing if you’re aspirin-resistant is a critical piece of information.

A Simple Test Will Tell You

The good news is that there is a new test that can determine whether you’re aspirin-resistant. A urine sample is all that’s needed.

The test is called AspirinWorks.  I urge you to find it and take it. If your medical history suggests that you’d benefit from a daily aspirin—but you test positive for aspirin-resistance, I would stay away from aspirin. Instead I would meet with your doctor for other blood-thinning options that might be better for you.

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