An aspirin a day? Doctors say not anymore
The old advice from doctors to start taking a baby aspirin each day to help protect against stroke and heart attacks no longer holds true.
New evidence of possible negative side effects and risks have changed the thinking in the medical community, shifting doctors away from recommending a daily aspiring for most patients.
“The original recommendation for a daily baby aspirin came from research done decades ago,” explains Dr. Amish Mehta, who is an Allegheny Health Network (AHN) cardiologist and the Director of Noninvasive Cardiology and Subchief of Cardiology at AHN Jefferson Hospital. “At that time, the research seemed to show that an 81 mg baby aspirin daily could decrease the risk of a normal healthy person having a heart attack or stroke. A baby aspirin affects the clotting of blood in our body by decreasing the activity of platelets to form blood clots. Therefore, aspirin is a mild blood thinner.”
That dosage was prescribed for decades for healthy men and women to prevent heart attack and stroke, which are two leading causes of death in the United States and account for nearly 25% of all U.S. deaths. Because aspirin acts as a blood thinner, it can also cause potential problems.
New guidance from the U.S. Preventive Services Task Force (USPSTF) no longer recommends daily aspirin to prevent a first heart attack or stroke among people 60 and older. Going further, the guidance now says adults ages 40 to 59 should only take a daily aspirin if they have a high risk of cardiovascular disease and as recommended by a doctor. Finally, the guidance concludes there is little benefit for people over age 75 to take a daily aspirin.
While taking a daily aspirin has been shown to help prevent a first heart attack or stroke, it can also cause other problems.
“Since aspirin is a blood thinner, it can cause bleeding,” says Mehta. “The worst danger of a baby aspirin is that it can cause bleeding in the brain, which can lead to permanent injury or death. It can also cause internal bleeding anywhere in the body including in the lungs, intestines and colon, or in the bladder for example.”
Why the change in thinking?
“Their recommendation is based on several very large, well-conducted research studies over the last few years on healthy populations throughout the world which gave half the people a baby aspirin daily, and the other half a placebo,” Mehta said. “These patients were followed for several years to determine how frequently they had heart attacks and strokes versus how frequently they had bleeding, which is a side effect of aspirin since it is a blood thinner.”
The research studies showed the benefits of a baby aspirin daily in preventing heart attack or stroke are neutralized by the bleeding that aspirin causes. The USPSTF conclusion is that it has become clear that a baby aspirin is not recommended for the average healthy adult. “In fact, many physicians, including myself, have not been recommending aspirin for healthy patients for years,” said Mehta. “However, aspirin definitely benefits certain patients. Any patient with a history of certain cardiovascular diseases including a heart attack, stroke, heart stent, or heart bypass or valve surgery, for example, who has been prescribed baby aspirin by their physician or health-care provider, should continue their aspirin daily.”
Mehta also believes aspirin definitely has a benefit in preventing future cardiovascular events in many such patients and stresses that no patient should stop their aspirin regimen without consulting with his or health-care provider.
What is Mehta advising his patients when it comes to aspirin’s benefits and risks?
“I am a firm believer in following the published cardiovascular research and evidence regarding the risks and benefits of any medication including aspirin,” he adds. “When it comes to aspirin, if the patient has a history of certain cardiovascular issues (heart attack, stroke, heart stent, or heart bypass or valve surgery for example) I recommend a baby aspirin daily with the exception of those on a different blood thinner. In healthy adults without specific cardiovascular diseases, I do not recommend a baby aspirin.”
The bottom line is the importance of discussing the benefits and risks of taking a daily aspirin with your doctor.
“It is important for individuals to realize that aspirin is a medication, and it should not be taken for granted,” Mehta says. “While it is beneficial to certain patients, it can be harmful to others. It is important for patients to discuss their medications with their health-care provider and if there is further question or concern, to consider seeing a specialist.”