Will An Aspirin A Day Really Keep A Heart Attack Away
Will an aspirin a day keep a heart attack at bay?
The answer: It depends.
If youve had a heart attack or stroke, or are at high risk for one , 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 diseaseincluding those who have undergone coronary artery bypass graft surgery or coronary artery stenting, stable peripheral artery disease or carotid artery disease.
Seniors Might Actually Be Harmed
The Aspirin in Reducing Events in the Elderly trial examined the preventive effects of 100 mg of aspirin daily versus a placebo in about 19,000 Australian and U.S. participants 70 years old and older who had no cardiovascular disease, dementia, or disability.
Researchers found no evidence that aspirin provided any cardiovascular benefit, although participants taking aspirin still showed a higher risk for major bleeding.
The ASPREE study also found the rate of death from any cause may even be higher in aspirin users in this age group.
So, should you take aspirin to reduce the risk of heart attack or stroke?
Its not a simple question to answer.
While doctors accept that aspirin will protect people who already have a diagnosis of cardiovascular disease, theyre less clear on whether it helps those who havent received a diagnosis.
If you already had a heart attack or stroke, then yes. Although the opposite is not a hard no, Dr. Robert Segal, cardiologist and co-founder of LabFinder, told Healthline. Depending on your lifestyle or health history, its best discussed with your healthcare provider.
How Did Evidencenow Evaluate Whether Practices Followed This Pcor Evidence
The measure used by EvidenceNOW to evaluate aspirin use reflects the percentage of patients with heart disease , patients with a history of a heart attack, and patients with a history of a stroke who use aspirin or a similar drug.
The National Quality Forum also endorsed this measure , which is used by the Centers for Medicare & Medicaid Services.
The EvidenceNOW goal for primary care practices in the study is to have at least 70 percent of patients for whom aspirin use is recommended be taking it or a similar drug.
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Evidence Shows Modest Benefits Of Aspirin Often Dont Outweigh Risks
The panels proposed recommendations are in line with existing evidence, says Jim Liu, MD. Previous studies through the years have suggested that aspirin offers only a very modest, if any, benefit in preventing cardiovascular disease, he says.
In the past three years, there have been a couple of large randomized trials once again studying aspirin for preventive purposes. These newer studies have all found no significant benefit to aspirin when it comes to preventing all-cause mortality or cardiovascular mortality, says Dr. Liu. These studies did still find a slight benefit in aspirin for preventing nonfatal heart attacks, but this benefit was mostly seen in higher cardiovascular risk patients who were also at low risk of bleeding, he adds.
Study: A Daily Baby Aspirin Has No Benefit For Healthy Older People
“Aspirin use can cause serious harms, and risk increases with age,” he said.
If finalized, the advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.
Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice.
The task force previously said a daily aspirin might also protect against colorectal cancer for some adults in their 50s and 60s, but the updated guidance says more evidence of any benefit is needed.
The guidance was posted online to allow for public comments until Nov. 8. The group will evaluate that input and then make a final decision.
The independent panel of disease-prevention experts analyzes medical research and literature and issues periodic advice on measures to help keep Americans healthy. Newer studies and a re-analysis of older research prompted the updated advice, Wong said.
Aspirin is best known as a pain reliever but it is also a blood thinner that can reduce chances for blood clots. But aspirin also has risks, even at low doses mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.
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How Does Aspirin Benefit The Heart
- Prevents blood clots. Aspirin blocks factors in the blood that cause blood clots to form. Blood clots are good when they stop bleeding but harmful when they clog the arteries leading to the heart or brain and increase the risk of heart attack and stroke.
- Aspirin reduces the risk of future heart attack and ischemic stroke in people with a prior history of these conditions.
- Reduces the risk of death. When taken during a heart attack, aspirin greatly reduces heart damage and increases the chance of survival.
Fact: Once Your Doctor Decides That Daily Use Of Aspirin Is For You Safe Use Depends On Following Your Doctor’s Directions
There are no directions on the label for using aspirin to reduce the risk of heart attack or clot-related stroke. You may rely on your health professional to provide the correct information on dose and directions for use. Using aspirin correctly gives you the best chance of getting the greatest benefits with the fewest unwanted side effects. Discuss with your health professional the different forms of aspirin products that might be best suited for you.
Aspirin has been shown to lower the risk of heart attack and stroke in patients who have cardiovascular disease or who have already had a heart attack or stroke, but not all over-the-counter pain and fever reducers do that. Even though the directions on the aspirin label do not apply to this use of aspirin, you still need to read the label to confirm that the product you buy and use contains aspirin at the correct dose. Check the Drug Facts label for “active ingredients: aspirin” or “acetylsalicylic acid” at the dose that your health professional has prescribed.
Remember, if you are using aspirin everyday for weeks, months or years to prevent a heart attack, stroke, or for any use not listed on the label without the guidance from your health professional you could be doing your body more harm than good.
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New Advice On Aspirin And Heart Health
Who is affected?
If finalized, the recommendation would affect most people in their 40s and 50s whose doctors might have prescribed low-dose aspirin as a preventive tool in the past. For years, people were advised to take a daily pill to try to avoid a first heart attack or stroke. Patients with questions should talk to their doctors.
The task force also said that no one over 60 should take low-dose aspirin as a new treatment if they have not had a heart attack or stroke.
How Should I Take It
First, tell your doctor if you are allergic to aspirin, ibuprofen, or naproxen. If you get the go-ahead to start an aspirin routine, then:
- Donât take it on an empty stomach. Take aspirin with a full glass of water with meals or after meals to prevent stomach upset.
- Donât break, crush, or chew extended-release tablets or capsules — swallow them whole. Chewable aspirin tablets may be chewed, crushed, or dissolved in a liquid.
- Aspirin should never be taken in place of other medications or treatments recommended by your doctor.
- Never take it with alcohol. That increases your chance of stomach bleeding.
Ask your doctor what other medicines you can take for pain relief or minor colds while you take aspirin. Read the labels of all pain relievers and cold products to make sure theyâre aspirin-free. Other drugs with aspirin or nonsteroidal anti-inflammatory drugs may cause bleeding when taken with your regular aspirin therapy.
Before any surgery, dental procedure, or emergency treatment, tell the doctor or dentist that youâre taking aspirin. You might need to stop taking it for 5 to 7 days before your procedure.
However, donât stop taking this medicine without first consulting with your doctor.
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Aspirin For Heart Attack Prevention
Aspirin can help prevent heart attacks in people with coronary artery disease and in those who have a higher than average risk. Only low dose, usually just 1 a day, is needed. But people who think they may be having an attack need an extra 325 mg of aspirin, and they need it as quickly as possible. For the best results, chew a single full-sized 325-mg tablet, but don’t use an enteric-coated tablet, which will act slowly even if chewed. And don’t forget to call 911, then your doctor. It’s a contemporary update on the old reminder to take two aspirin and call in the morning and it’s good advice to chew over.
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Expert Tips On Reducing Your Risk Of Heart Disease
The American College of Cardiology and American Heart Association offer an online prediction tool to calculate your 10-year risk of heart disease. If your current risk level doesnt indicate that aspirin is appropriate, there are still many ways to optimize your cardiovascular risk profile and reduce your chances of a first heart attack or stroke, says Wilkins.
- Optimize your blood pressure and cholesterol levels. That can be achieved through lifestyle modifications, and for some people, that may mean medications, he says.
- Try to eat a balanced and healthy diet, get the recommended amount of physical activity, and have a BMI within the normal range.
- Avoid all tobacco products.
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Is There More Harm Than Benefit
Previous guidelines from the United States Preventive Services Task Force warned against taking aspirin for the primary prevention of heart disease unless youre at an elevated risk typically if youre 50 to 69 years old with a 10 percent or greater chance of having a heart attack or stroke within the next 10 years.
There is good reason to be wary of aspirin, warns Michos, particularly for women. The Womens Health Study was a large trial that looked at whether women with no history of heart disease would benefit from taking a low dose of aspirin. Researchers found that in the overall group of women, aspirin didnt reduce the risk of heart attacks, but it did increase the risk of bleeding. Some benefit was seen for women over the age of 65.
So not only was there lack of benefit for the younger women taking aspirin, but there was also a question of harm, says Michos. Its important for people to realize that just because aspirin is over-the-counter does not mean it is necessarily safe. Many patients take aspirin because they think its good for their hearts, but it carries some serious risks.
The best way to assess your risk level is to talk to your doctor about it. Your doctor can help you weigh the risks and benefits to determine if low dose aspirin therapy is right for you.
Is It Safe For People With Diabetes To Take Aspirin
However, serious bleeding events can also happen, such as bleeding events in the gastrointestinal tract or brain. Because of this, a healthcare professional must weigh the benefits of daily aspirin against its potential risks.
According to a 2019 report, the ADA only recommends daily aspirin at a dose of 75 to 162 milligrams per day for people with diabetes and a history of cardiovascular disease.
The ADA notes that daily aspirin may also be considered for people with diabetes who are at an increased cardiovascular risk. You may be at an increased cardiovascular risk if you are 50 or older and:
- have a personal history of:
- high blood pressure
However, its important to discuss the risk of bleeding events with your doctor. Its also possible that your doctor will want to assess your risk of bleeding before recommending daily aspirin.
Where Do The Experts Stand On Daily Aspirin
The proposed recommendations, which arenât final, come from an independent panel of experts in disease prevention and evidence-based medicine called the U.S. Preventive Services Task Force . The group is planning to revamp its 2016 recommendations on aspirin after reviewing newer studies.
The task force is proposing these recommendations:
- People 40 to 59 years old who are at higher risk for heart disease or stroke and donât have a history of either condition should talk to their doctor about whether they should start taking aspirin as preventive step.
- People 60 and older shouldnât start taking aspirin to prevent heart disease and stroke. The task force says the risk of internal bleeding due to aspirin, which rises with age and can be life-threatening, cancels out the benefits of preventing heart problems in people 60 and older.
Still, if youâre already taking aspirin because youâve had a heart attack or stroke, donât stop taking it unless your doctor tells you to, the task force says.
The USPSTFâs draft recommendation statement is open for public comment on its website.
What Is The New Guidance About Daily Baby Aspirin
Here are the new guidelines, which are currently in draft form and should be finalized by the end of the year:
- Adults ages 60 and older who have not had a prior heart attack, stroke, stents or heart or artery surgery, or significant atherosclerosis should not start taking daily baby aspirin. Thats because theres no net benefit when considering the associated bleeding risks, according to the prevention experts.
- People ages 40 to 59 who have a greater than 10% risk of having a stroke or heart attack over 10 years may get a small net benefit from taking a daily low-dose or baby aspirin. These people should consult with their doctors to weigh the pros and cons.
- People who have already had a stroke or heart attack and have been advised by their doctors to take a daily baby aspirin should continue with their aspirin regimen. Anyone with questions about their specific circumstances should consult with their doctor prior to stopping aspirin.
Simon emphasizes that the new guidance does not apply to everyone. Initial headlines might have made it seem like everyone should immediately stop taking baby aspirin. Thats not correct, Simon said.
This applies to a very specific patient group, he said.
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Nsaids And Cardiovascular Disease: Minimizing The Risks
There are several factors to consider when evaluating the potential risk of NSAID therapy. The first is the duration of treatment. The risk of having a heart attack or stroke is extremely small over a short course of therapy , such as would be the case in treating acute pain from a musculoskeletal injury like tendonitis. Another important consideration is dose and frequency. The risk tends to increase with higher doses and increased frequency. The third factor is whether the person has existing cardiovascular disease. In people without known cardiovascular disease, the absolute increase in risk is incredibly small .
My general principles for NSAID use are:
What Pcor Evidence Did Evidencenow Use
Here are the PCOR findings used by EvidenceNOW for aspirin use:
In 2011, the American Heart Association and the American College of Cardiology Foundation used PCOR evidence to develop guidelines on aspirin use in patients with heart disease and others who are at risk of heart attack or stroke .
Recommendation: Based on the evidence, the panel recommended long-term, low-dose aspirin therapy for patients with heart disease. For patients intolerant or allergic to aspirin, clopidogrel can be used as an alternative.
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