Will an aspirin a day keep a heart attack at bay?
The answer: It depends.
If you’ve had a heart attack or stroke, or are at high risk for one (and not at risk for bleeding), your doctor may recommend you take a daily aspirin. Aspirin has long been promoted for its benefits to those with heart and cardiovascular disease. It can help reduce the risk of blood clots forming inside an artery and blocking blood flow to the heart or brain. Aspirin use could also play a role in the prevention of certain cancers, such as colon and rectal cancers.
“There are several groups of patients with established heart disease who benefit from aspirin to prevent developing recurrent cardiovascular events, also known as secondary prevention,” said Brian Henry, MD, a cardiologist at Banner Health in Colorado. “These include patients with a history of heart attack, ischemic stroke and stable ischemic heart disease—including those who have undergone coronary artery bypass graft surgery or coronary artery stenting, stable peripheral artery disease or carotid artery disease.”
Not beneficial for everyone
But if you don’t have any heart issues, you may want to think again about taking one. Current research shows that taking a daily aspirin may do you more harm than good.
This may be confusing for many older adults, especially those who were at low and moderate risk but had been taking a daily aspirin as an easy, cost-effective method of prevention. In fact, in 2017, nearly 30 million adults, who had no history of cardiovascular disease, reported using aspirin, and many without a doctor’s recommendation.
While it’s long been touted as a way to prevent heart attack, stroke and other serious heart events, a most recent analysis of 67 studies by the British Pharmacological Society found that the use of a low-dose aspirin by adults without heart disease was associated with only a 17% lower occurrence of a cardiovascular event, like heart attack or stroke, but a 47% higher risk for gastrointestinal bleeding and 34% higher risk of bleeding in the brain.
“For those who are at low risk for a heart attack and stroke, the overall risks outweigh the benefits to warrant long-term daily use of aspirin,” Dr. Henry said. “The main safety concern with using aspirin long-term is bleeding, chiefly in the gastrointestinal tract. Although rare, aspirin also increases the risk of cerebral hemorrhage, which can be fatal.”
A change in guidelines
This prompted the American College of Cardiology and the American Heart Association to change guidance in 2019 to recommend that aspirin not be routinely used for heart disease prevention in adults older than 70 or adults of any age who are at an increased risk for bleeding. A low-dose aspirin "might be considered for the primary prevention" of heart disease among select adults aged 40 to 70 who are at higher risk for the disease, but not at increased risk of bleeding.
“For a wide range of patients who have survived a cardiovascular event, the increased risk of bleeding from long-term aspirin use is far less than the decreased risk of another heart attack, stroke or cardiovascular death,” Dr. Henry said. “Therefore, most secondary prevention patients should be prescribed aspirin for long-term use.”
Should I take a daily aspirin or not?
The decision to use aspirin therapy for those ages 40 to 70 is complicated. Bottom line: Talk to your doctor before starting. If you were put on an aspirin regimen for primary prevention, but don’t have a history of heart disease, don’t just stop cold turkey either. Instead, talk to your doctor about whether you still need to be taking it or not.
“The decision regarding aspirin for primary prevention among healthy patients should be individualized based on patient preference after discussion of the potential benefits and risks,” Dr. Henry said. “Practitioners and patients should have discussions which include patient values and preferences regarding cardiovascular disease, colorectal cancer and major bleeding. While many tools are available to estimate benefits and risks of disease, they all have limitations.”
Don’t forget to adopt healthy heart habits
Whether your doctor makes the recommendation for aspirin or not, all experts can agree adopting certain heart-healthy lifestyle habits can help protect your heart and overall health.
For heart-healthy tips, check out “Five Fantastic Tips to a Healthy Heart.”
Put your heart in the right place
If you are unsure of your risk factors and how to keep your heart healthy, take the Heart Age Test, which evaluates your answers to questions about lifestyle and genetic risk factors to estimate your heart disease risk. From there, you can work with your doctor or a Banner Health expert to plan your next steps to a healthier heart.
To schedule an appointment with a Banner Health specialist, visit bannerhealth.com.