Aspirin: should you take it daily or not?

New 'earth-shattering' guidelines turn the wisdom on aspirin upside down. Again. Learn what's right for you.
May 21st, 2019

As it turns out, an aspirin a day may not keep the doctor away. In fact, it could do the very opposite.

The ever-changing guidelines for our health seem as amorphous as a cloud of smoke. One day coffee is good for you, the next it’s bad. Then they say it’s OK in moderate amounts. And so on.

Now, there are new guidelines for taking aspirin.

An older person takes baby aspirin.
The advice on aspirin has changed again. Don’t take it every day without talking to your doctor. Photo: Getty Images.

The U.S. Preventive Services Task Force recently recommended that you could use aspirin as a primary preventative (against heart disease) in certain patients, specifically between the ages of 50 to 59, because they thought there were good cardiovascular benefits,” said Dr. Mohamad Lazkani, who practices interventional cardiology at the UCHealth Heart and Vascular Clinics, primarily at the Harmony campus in Fort Collins and at the Loveland clinic.

“Aspirin was considered this great miracle drug, but as more data started coming out in the past few years, we’ve been seeing consistent adverse outcomes” in some patients, Lazkani said.

The news is “really quite earth-shattering. It’s really flipped the medical community on its head,” said Dr. David Rosenbaum, who practices cardiovascular medicine at the UCHealth Heart Center at Memorial Hospital North in Colorado Springs.

The new guidelines are “based on looking at patients and assessing their risk for using aspirin,” Lazkani said. “There is increased risk of bleeding if you use it in specific patient populations, such as the elderly. So they’re finding that it’s not just a magic pill you can give everyone, because it does have some risks of harm in certain people.”

The American Heart Association and the American College of Cardiology, which counts 95% of cardiologists as members, both supported the new guidelines.

“This was really groundbreaking research. It called into question the overall effectiveness of aspirin,” Rosenbaum said.

The benefits compared to placebos were minimal.

“And the risk of bleeding that one might experience was higher,” he said.

The main issue was that aspirin can cause gastrointestinal or hemorrhagic (brain) bleeds, Lazkani said. The latest guidelines reinforce the wisdom that aspirin use should be tailored to specific patients, not prescribed for everyone.

“I think this latest recommendation is good because I personally advocate patient-physician collaboration in decision making. It gives patients ownership of their care,” Lazkani said. “Everything we do in medicine has risks and benefits and we’re always weighing the balance.”

STAYING HEART HEALTHY

Dr. David Rosenbaum shares some basic health rules with his patients, designed to reduce the risk of heart disease. They include:

Life’s Simple Seven:

  1. Don’t smoke.
  2. Maintain a healthy weight.
  3. Get adequate physical exercise.
  4. Eat a balanced, healthy diet.
  5. Keep cholesterol in check.
  6. Aim for low blood pressure.
  7. Achieve healthy blood glucose levels.

“The American Heart Association has found that only 17% of U.S. adults have these metrics at ideal levels,” Rosenbaum said. He also uses the following to help patient remember the rules for good health.

The ABCs of Health:

A – assess the risk of aspirin

B – blood pressure control

C – cholesterol control

C – cigarettes – stop smoking (or never start)

D – weight and diet (high in vegetables, fruits, nuts, legumes and whole grains)

D – diabetes control, by diet and exercise or medication if necessary

E – exercise – get some regularly

Why all the concern about a drug that has been widely used for more than 100 years?

Aspirin “works on platelets, which prevent bleeding. Aspirin inhibits platelet function, which lowers the threshold for bleeding,” said Dr. William Cornwell, who specializes in advanced heart failure and transplant cardiology at the UCHealth Heart and Vascular Center – Anschutz Medical Campus in Metro Denver.

Some patients should take aspirin, he added.

“Certainly, people who have heart disease. If you have a history of heart attack or stroke, use it for secondary prevention, to reduce the risk of a second event. In the absence of a clear contraindications, they should be taking aspirin.”

The guidelines say aspirin should not be administered on a routine basis as primary prevention, however, he added.

“For select patients, who are 40-70 years of age, if those individuals are at high risk for a future event, then we might prescribe aspirin as primary preventative. But for patients older than 70, it should generally not be given for primary prevention, because the bleeding risk is high.”

Rosenbaum agreed.

“I don’t know that just anybody should be receiving aspirin on a regular basis,” Rosenbaum said. “If someone has had a heart attack, a stroke or major vascular disease, they should be on aspirin as a secondary treatment. But the number of people who should be on aspirin has just shrunk by millions.”

Cornwell noted that although taking aspirin is not recommended prior to a transplant or other heart procedures, it often is prescribed afterwards.

The study covered the whole spectrum of cardiovascular care.

“It’s more than just the aspirin guidelines, but what has happened in late March was an update in all the prevention guidelines. It’s the 2019 (guide) for primary prevention of heart disease, a 100-page document. It’s an all-encompassing review of multiple aspects of self-care and health care as far as how to prevent cardiovascular disease. It’s about much more than aspirin. That’s just the headline-grabbing component,” Rosenbaum said.

Should the average person still take an aspirin for a headache?

According to Cornwell, “aspirin has long been known to inhibit prostaglandin formation, a hormone that causes pain. When taken intermittently to treat a headache, it is probably okay.”

However, he hesitates to say that aspirin should be the “go-to” pain reliever for everyone.

“Be sure to speak with your doctor about the risks and benefits of using aspirin for pain relief,” Cornwell said, particularly for individuals suffering from frequent headaches. In these cases, Cornwell added, there are several different – and very effective – medications that can be used to treat a headache or even prevent one from starting in the first place.

“A single dose here or there as a pain reliever is likely benign if you don’t have any risk factors for bleeding. But there are other medications for pain relief.”

About the author

Linda DuVal is a freelance writer based in Colorado Springs who writes articles for UCHealth.