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An aspirin a day: is it right for you?

By Howard Seidman, Staff Writer, myOptumHealth

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Aspirin has long been touted as a wonder drug. The ancient Greeks used the natural form of aspirin, which came from willow trees, as medicine.

Aspirin is a staple for treating headaches, aches and pains. Studies show it can also help prevent heart attacks and strokes.

If aspirin can help treat so many conditions, should you take it every day?

Recommendations

The need to take aspirin every day may depend on your risk for heart attack or stroke and your age. Any need also has to be balanced with the potential for aspirin to cause bleeding in the stomach or intestines.

The U.S. Preventive Services Task Force (USPSTF) provides these guidelines for doctors to use:

• Encourage men between ages 45 and 79 to use aspirin when the potential benefit of cutting heart attack risk outweighs the potential harm of increased bleeding in the stomach or intestines.
• Encourage women from 55 to 79 to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of more bleeding in the stomach or intestines.
• Women younger than 55 years old and men younger than 45 should not be advised to take daily aspirin to prevent heart disease.
• For people age 80 years or older, there is not enough evidence to recommend taking aspirin to prevent heart disease.

These guidelines are only for "primary prevention" of heart disease. That means people who have not had heart disease in the past. If you already have heart disease, talk with your doctor to see if aspirin or some other blood thinner is advised to help prevent future heart attacks or strokes.

Reducing risk factors

Before you start aspirin therapy, talk to your doctor. Your doctor will look at other factors besides the USPSTF guidelines when deciding if aspirin is right for you.

If you've already had a heart attack or stroke, your doctor may prescribe aspirin therapy to prevent you from having another.

If you have not had a heart attack or stroke, but have certain risk factors, you may still be advised to take it. These risk factors include:

• Age
• High total cholesterol level
• Smoking
• A family history of heart disease
• Diabetes
• High blood pressure

Early research suggests that aspirin may help prevent some cancers, but doctors don't recommend it for that purpose yet. More research is needed to see if any benefit would outweigh the risks.

Does aspirin therapy affect men and women differently?

One study showed that aspirin seems to be better at preventing a first stroke in women and a first heart attack in men. Men have a greater risk of having a heart attack than women until age 65.

The risk for women having a heart attack rises sharply after menopause. Plus, women are always at higher risk than men for having strokes. Both men and women face equal risks for stomach and intestinal bleeding from aspirin use.

What dose is safest and most effective?

Doctors are not sure what dose of aspirin is most effective to prevent heart attack or stroke. Higher doses may increase the risk of bleeding, but even at low doses there are still risks for:

• Stomach ulcers
• Bleeding strokes
• Ringing in the ears and hearing loss
• Allergic reactions

If your doctor suggests aspirin therapy, ask what dose is right for you.

Potential drug interactions

Aspirin may interact poorly with other medications. For instance, ibuprofen and other anti-inflammatory medicines can block the effects of aspirin, and raise your risk for ulcers and bleeding by four times. Also, taking aspirin with other blood-thinning drugs can thin the blood too much. This can raise your risk of major bleeding complications.

If you take daily aspirin, talk to your doctor before any surgery, including dental work. You run the risk of excessive bleeding during surgery.

Finally, stopping aspirin may cause blood clots. Always talk to your doctor before you start or stop any medication, even over-the-counter ones.

View the original An aspirin a day: is it right for you? article on myOptumHealth.com 

SOURCES:

• American Heart Association. Aspirin in heart attack and stroke prevention. Accessed: 05/04/2007

• Jacobs EJ, Thun MJ, Bain EB, et al. A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence. Journal of the National Cancer Institute. 2007; 99(8):608-615. Accessed: 07/02/2007

• U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2009;150(6):396-404. Accessed: 04/13/2009

• Ridker PM, Cook NR, Lee I-M. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. New England Journal of Medicine. 2005;352:1293-1304.

• American Heart Association. Diabetes and aspirin. Accessed: 05/04/2007