Sudip Saha, MD, is a board-certified cardiologist with the Mid-Atlantic Permanente Medical Group. He cares exclusively for patients of Kaiser Permanente. Dr. Saha sees patients at the Kaiser Permanente Tysons Corner Medical Center and offers patients video and phone visits when appropriate.
You may have heard that a baby aspirin a day can keep heart attacks and strokes away. This has been the prevailing notion for years: A daily low-dose aspirin helps prevent heart attacks and stroke.
But, while taking baby aspirin has helped countless people prevent heart attack and stroke, research now shows that daily use may do more harm than good for some people.
In fact, the U.S. Preventive Services Task Force updated its recommendations a few years ago. People who have a history of heart attack, atrial fibrillation, stroke or a vascular stent should continue to take low-dose aspirin under a doctor’s guidance. But for people aged 60 or older who want to prevent a first heart attack or stroke, a daily low-dose aspirin is not recommended. The risk of side effects outweighs the potential benefits.
As a board-certified cardiologist with the Mid-Atlantic Permanente Medical Group/Kaiser Permanente, I often talk to patients who are confused by the new recommendations. They are looking for clear-cut guidance on whether to take a low-dose baby aspirin daily, or whether to stop doing that (if taking it is already part of their routine). Here’s what people should know.
Impact on Platelets
Aspirin makes platelets less sticky. A heart attack or stroke is a highly inflammatory event for your blood vessels. In someone experiencing a heart attack or stroke, platelets rush to the affected area to form a clot. A clot can be dangerous: Clots can prevent blood flow to the brain and other organs. They also can travel throughout the body, causing serious blockages. Aspirin is an “antiplatelet agent,” meaning it is a blood thinner that makes platelets less sticky and less likely to form a clot.
Aspirin for Heart Attacks
When we suspect someone is having a heart attack, we give them (or urge them to take) aspirin right away, in most cases. If you think you are having a heart attack, chew four tablets of aspirin that are 81 mg each and call 911. Heart attack symptoms include chest pain, sweating, shortness of breath, lightheadedness, weakness, nausea, vomiting and pain or pressure in the back, neck, jaw, shoulders or arms. (Do not take aspirin if you are allergic to it or have a known significant bleeding disorder.)
Side Effects
Aspirin can cause unwanted side effects. In people not actively experiencing a heart attack, stroke or other cardiovascular event, we are now more cautious about aspirin because we know more about the risks of taking aspirin daily. Regular aspirin use can increase risk of gastrointestinal bleeding (such as a stomach ulcer) and, in rare cases, brain bleeding. And as your age increases, so, too, does your risk of these dangerous side effects.
Is It Right for You?
If you are ages 40 to 59 and have a 10 percent or greater 10-year risk of cardiovascular disease — but you do not have personal history of heart disease — discuss with your doctor whether starting to take a low-dose daily aspirin is right for you. Your doctor can calculate your risk over the next 10 years of if developing heart disease or having a stroke. The benefit for taking aspirin as a preventive measure to reduce the risk of heart disease may be small for people in this age bracket.
If you are age 60 and older and have no personal history of heart disease, we don’t recommend taking a daily baby aspirin to help prevent a first heart attack or stroke. The U.S. Preventive Services Task Force now recommends against starting low-dose aspirin for the primary prevention of cardiovascular diseases in adults 60 years old or older. Primary prevention means you haven’t previously had a cardiovascular event, such as a heart attack or stroke. What if you are 60 or older and have been taking baby aspirin daily? Talk to your doctor about whether you should stop. Don’t stop without discussing it with your doctor. Stopping suddenly could lead to other health problems.
Talk to Your Doctor
If you previously had a heart attack or stroke, your cardiologist likely will recommend you take aspirin daily to prevent a second heart attack or stroke. This is called secondary prevention. Your doctor will recommend the right dose for you: Some patients do well with a low dose of daily aspirin, and others will need a higher dose.
If you take aspirin, remember to tell your doctor. Since it is available over the counter, many patients forget to tell their doctor that they take aspirin regularly. Please make sure your doctor knows if you take aspirin. Other medications you are on may interact with aspirin. And regular aspirin use may put you at increased risk of other medical conditions.
Feature image, stock.adobe.com
