Do You Really Need That Daily Aspirin?
(This post originally appeared on Iodine’s blog)
Looking to stave off a heart attack or stroke? Your first inclination might be to pop a daily aspirin. It turns out that may be a misstep.
A study in the Journal of the American College of Cardiology (JACC) recently found that a significant proportion of people are currently taking a daily aspirin without cause.
The benefits of daily aspirin use
To be sure, after someone suffers a heart attack or stroke, taking an aspirin a day can help prevent another such cardiovascular (CV) event from happening. But whether an aspirin can help prevent someone from having a CV event in the first place is still hotly debated.
The current guidelines on prevention state that only people with a 6% chance or higher of having a heart attack or stroke in the next 10 years should be taking an aspirin on a daily basis. But in a group of nearly 70,000 patients, the JACC study found that almost 12% of them were taking aspirin inappropriately.
The risks of daily aspirin use
One thing physicians are concerned about when it comes to taking aspirin regularly is the chance of gastrointestinal bleeding. Aspirin thins the blood, which is one of the reasons it works so well to keep blood moving after someone has a heart attack or stroke due to a blocked blood vessel. But aspirin can irritate the gastrointestinal lining, making it more susceptible to bleeding, which can be serious, sometimes requiring a blood transfusion.
Who else should be concerned? People with kidney or liver disease should not be taking aspirin. Also, those with high blood pressure should avoid it because they have an increased risk of hemorrhagic stroke due to the possible rupture of small blood vessels in the brain and the inability of thinned blood to clot.
Using aspirin in emergency settings
While some are taking an aspirin a day when they don’t need to, not enough people are receiving an aspirin when they actually require one, such as immediately after they’ve had a heart attack. This includes people treated by Emergency Medical Service (EMS) personnel. According to a new study, about half of the people suffering a heart attack did not receive an aspirin before they reached the hospital.
How important is it to take an aspirin as soon as someone is exhibiting symptoms of a heart attack? It’s crucial. One estimate claims that people are more than 20% less likely to die from a heart attack if they take an aspirin, the earlier the better.
How to decide if a daily aspirin is right for you
According to the U.S. Preventive Services Task Force (USPSTF), women over the age of 55, and men over the age of 45 should be taking a daily aspirin to prevent CV events. In fact, when people hit those age milestones, the USPSTF gives preventive treatment a grade of “A”, presumably acting as a proxy for its importance.
However, they have a note in the risk column stating that you should consult with your doctor before you start taking an aspirin every day due to the consequences of internal bleeding described above. The decision to take aspirin regularly, the site says, should depend on CV disease risk factors, such as high cholesterol, elevated blood pressure, and whether the person is a smoker or not. However, the recommendation only appears if you are over the age of 45. In other words, the guideline previously mentioned that only people with a 6% or higher risk of having a CV event in the next 10 years is missing.
This highlights the difference between precision- and population-based medicine. The USPSTF guidelines are based on what happens in the general population, where data from an average distribution of risk shows age to be a strong predictive element. Yet from a precision medicine standpoint, there might be people younger than 45 who should be taking a daily aspirin based on their 10-year risk profile.
The safe dose range for aspirin is quite wide, with people taking somewhere between 50 and 325 mg per day. Because of all the mixed factors, the various pros and cons, you should always talk to your doctor before starting a daily aspirin routine. After all, aspirin is not a vitamin, it’s a drug. We need to treat it like one.
Note: Interested in what your 10-year risk of cardiovascular disease might be? Try this online calculator.
Brian Mossop is a freelance science/technology writer and consultant. Follow him on Twitter.
