#048 Should I Take an Aspirin Every Day?

November 22nd, 2014 by

Should I Take an Aspirin Every Day?

For many years, physicians have asked people with risk factors for heart disease or stroke to take an aspirin every day.  The idea was that an aspirin every day might prevent a heart attack, stroke, or even premature death.  Millions have followed their doctor’s advice and have faithfully taken their aspirin every day.

This past week at the annual American Heart Association meetings in Chicago this philosophy was turned completely upside down.  The results of this study hit the worldwide press and, as I can attest, created quite a buzz after the results were presented.  In addition to being presented in Chicago this past week this study was also simultaneously published in the prestigious Journal of the American Medical Association.

The Daily Aspirin Study

In this study, 14,646 Japanese were evenly randomized to either 100 mg of aspirin or no aspirin and were following for an average of about 5 years.  None of these people had heart problems or a stroke prior to entering into this study.  All of these people were definitely at risk for a heart attack or stroke as they were all at least 60 years old and had high blood pressure, high cholesterol, or diabetes.

At the end of 5 years they found that 2.77% of the people taking aspirin had a heart attack, stroke, or died.  Similarly, they found that 2.96% of the people not taking an aspirin suffered a heart attack, stroke, or died.  Statistically, there was no difference between these numbers.

While aspirin did not prevent heart attacks, strokes, or premature death it did put the people taking an aspirin at much higher risk of a bleeding complication.  The most serious bleeding complication, bleeding inside the brain or skull, was seen in 31 people in the aspirin group compared to just 14 people in the no aspirin group.  Major bleeding elsewhere in the body was also about twice higher in the aspirin group.

The bottom line from this study of more than 14,000 people was that in people with no prior history of cardiovascular problems, an aspirin a day does not offer any benefit.  Moreover, an aspirin every day puts people at a much higher risk of major bleeding.

Should I Take an Aspirin Every Day?

The question now is should I take an aspirin every day?  The answer is it depends.  Here is my take on this study and how I will advise my patients.

1. If you already have cardiovascular disease then this study does not apply to you.

If you are on an aspirin, please continue to take your aspirin under the direction of your physician.  Aspirin has been shown to be protective in people who already have cardiovascular disease.

2. If you take an aspirin each day just to “prevent” a heart attack, stroke, or premature death then the results of this study would argue that aspirin does not offer any benefit and may even put you at risk of a catastrophic bleed.

If your physician has prescribed an aspirin for “preventative” reasons, please discuss with your physician whether or not you should continue this medication based on the results of this study.  I have a link to this study above if you want to share it with your physician.

3. Medications, including relatively “benign” over-the-counter medications like aspirin, can have serious life-threatening complications.

This also applies to supplements which are unregulated and can also have life-threatening side effects.  Medications or supplements should only be taken under the careful supervision of a healthcare provider.

4. The best way to prevent a heart attack, stroke, or premature death is through a healthy lifestyle.

Eating plenty of fruits, vegetables, nuts, seeds, legumes, oily fish in combination with daily physical activity, stress management, restorative sleep, and close relationships is far more effective than any pill at preventing a heart attack, stroke, or premature death.

Have you or a loved one been prescribed an aspirin to prevent cardiovascular disease?  Did the results of this study surprise you?