Daily Aspirin Therapy: The Benefits And Risks

It’s no secret that heart disease is the nation’s number one killer. Historically, doctors recommended aspirin to high-risk patients as a harmless way to keep heart disease at bay. And for good reason – studies have shown that aspirin can reduce inflammation, prevents blood clots and lowers the risk of death among people suffering from a heart attack. But it turns out, there’s more to the story.

"While taking an occasional aspirin to quiet headaches, muscle strain or inflammation is generally safe, taking aspirin daily comes with some serious risks, including internal bleeding," warns Penny D'Souza, D.O., a cardiologist with Henry Ford Health. "If you are taking aspirin but are at low risk of a heart attack, or don't know your risk, have a discussion with your physician about whether taking daily aspirin is still recommended for you."

Here are seven facts to consider before you begin an aspirin therapy regimen:

1. The Food and Drug Administration (FDA) has never approved aspirin for primary prevention. For decades, doctors have prescribed aspirin to patients with no history of heart disease to prevent a future event. However, the American College of Cardiology no longer recommends daily aspirin to patients at low risk of a heart attack or stroke. This research explains that the risk of taking aspirin daily (between 81 and 162 milligrams) outweighs the potential benefits.
2. Aspirin could save your life if you’ve had a previous stroke or heart attack. If you have had a stroke or heart attack before, your doctor will likely recommend daily aspirin therapy to prevent a second event. Taking aspirin daily can help reduce the chance that blood clots will form inside diseased arteries. It can also minimize heart damage during a heart attack – preventing the occurrence of future events.
3. Low-dose aspirin can have serious side effects. Aspirin thins the blood (that’s how it prevents blood clots), so it’s no surprise that taking a daily aspirin increases the risk of internal bleeding. "Usually, it causes bleeding in the gastrointestinal tract (primarily the stomach and small intestines), but bleeding can also occur in other areas of the body," says Dr. D'Souza. If you are at risk for internal bleeding or experience stomach irritation while talking aspirin, talk to your doctor right away.
4. Age makes a difference. Daily aspirin is typically considered most effective for adults age 50 to 59 who have had a cardiac episode before. In some cases, aspirin can still be used as a preventative method if you are between ages 50 to 70 and are at low risk of internal bleeding. Healthy, low-risk patients younger than 50 and older than 70 can put themselves at risk by using aspirin.
5. Combining aspirin with some medications may lead to serious complications. Like aspirin, non-steroidal anti-inflammatory medications, or NSAIDs, such as ibuprofen (Advil) and naproxen (Aleve), thin the blood and reduce clotting. Taken together, the two can increase your risk of internal bleeding. Also, taking an NSAID before you take your aspirin may minimize the desired effects for prevention of heart attack or stroke. Other drugs, too, increase your risk of bleeding, including warfarin (Coumadin), corticosteroids and some antidepressants. If you need to take any of these regularly, talk to your doctor about alternative or additional therapies that may protect you from gastrointestinal bleeding (like switching to acetaminophen-based pain medications (Tylenol) or taking Prilosec).
6. Stopping aspirin without physician instruction could have deadly consequences. If you have had a previous heart attack, bypass surgery or have a stent placed in one or more of your heart arteries, you should always talk to your doctor before making any changes to your aspirin regimen. While it may be necessary to hold your aspirin temporarily for a procedure or surgery, these interruptions should be brief and infrequent.
7. Statins are safer for primary prevention than aspirin. If you’re concerned about your heart disease risk, ask your doctor if you’re an appropriate candidate for a class of drugs called statins. Studies published in the Journal of the American Medical Association report that statins not only reduce cholesterol levels in the blood, they can also lower the risk of heart attack, stroke and even death from heart disease by up to 20-30%. Your doctor can assess your 10-year risk of suffering from a heart event. If it’s over 7.5%, taking a statin may be your best bet.

No matter what you do though, never self-prescribe aspirin without getting an accurate heart assessment. Only then will you and your doctor really know whether the benefits of aspirin therapy outweigh the potential risks.

Making Changes To Reduce Your Risk Of Heart Disease

Healthy lifestyle changes are the best and most effective way to prevent a first heart attack or stroke. Consider these steps to help minimize your risk:

• Stop smoking
• Reduce stress by implementing relaxation techniques and practicing mindfulness
• Get started on a regular fitness regime
• Eat a heart healthy diet

Want to get started? Take our heart risk quiz to find out how healthy your heart is.

To find a cardiologist at Henry Ford, visit henryford.com or call 1-800-436-7936.

Dr. Penny D’Souza is a cardiologist who sees patients as Henry Ford West Bloomfield Hospital.