A daily aspirin isn’t right for everyone
Q: Should I be taking a low-dose aspirin to prevent heart attacks and strokes?
A: Maybe not. Recent research has shown that low-dose aspirin may not be necessary and may even introduce additional unnecessary risks in certain people.
Strokes and heart attacks, also called myocardial infarctions, can occur due to buildup of plaque in the arterial walls causing narrowing of the blood vessels. This plaque can break away or rupture, leading blood clots to form, which can prevent adequate blood flow to the heart and brain tissue and lead to heart attacks and strokes.
To reduce the likelihood of these clots, many people are currently taking daily low doses of aspirin — between 75 and 100 milligrams by mouth daily, usually 81 milligrams. For decades, doctors and public health experts encouraged this, based on earlier studies indicating it might reduce health risks.
However, that stance has changed. We now have better ways to treat risk factors for heart attacks and strokes, such as improvements in blood pressure and cholesterol control.
Furthermore, recent evidence has shown that aspirin may pose a higher bleeding risk for certain populations.
Here is a summary of current recommendations from the American College of Cardiology and the American Heart Association regarding aspirin use for prevention of a first heart attack or stroke:
Low-dose aspirin should be avoided for primary prevention in:
Adults older than 70 without a history of heart attack or stroke
Any adults without a history of heart attack or stroke but who have an increased risk of bleeding (see below)
People at increased bleeding risk includes those with a history of previous gastrointestinal bleeding, peptic ulcer disease, or bleeding from other sites; people older than 70; and people suffering from thrombocytopenia, coagulopathy and/or chronic kidney disease.
Low-dose aspirin might be considered for primary prevention in adults aged 40 to 70 who are at high risk for a heart attack or stroke but who do not have an increased bleeding risk.
Bleeding risk is also increased when aspirin is taken along with other medications that can increase bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen; steroids such as prednisone; direct oral anticoagulants including dabigatran, rivaroxaban, apixaban edoxaban; and warfarin.
People are at higher risk for heart attacks and strokes if they have a strong family history of premature heart attacks. This includes heart attacks in men aged 55 or younger and women aged 65 or younger.
Additional risk factors include not being able to achieve healthy levels of cholesterol, blood pressure or blood glucose. As a result, properly controlling these factors is critical to lowering the risk of future complications.
Another risk factor is a significant elevation in coronary artery calcium. This is determined with a CT scan of the heart to evaluate how much calcium deposits are in the coronary arteries. If you are concerned about your risk and are not currently taking a statin, ask your medical provider about this test.
Overall, patients who have already had a heart attack or stroke should continue to take their daily aspirin to reduce the risk of future events. But many patients who have not had a heart attack or stroke may not need to take a daily aspirin anymore.
Please talk with your healthcare provider about the risks and benefits of daily aspirin use before making any changes to your medication therapy.
Christian Hambrick is a fourth-year Pharm.D. student at VCU School of Pharmacy.