It is likely that many people reading this article take a baby aspirin daily. Have you ever stopped and asked why? This is actually a much more complicated answer than a simple yes or no. While there is great clinical evidence that supports the use of aspirin in preventing a heart attack or stroke in someone who has already experienced one, the use of aspirin in someone who is healthy is unclear.
Here is where there are differing opinions by some major health organizations. The US Preventative Services Task Force (USPSTF) is an independent panel of healthcare experts who determine effective screening and prevention guidelines using the most up to date clinical evidence. They currently recommend that all men between the ages of 45 and 79 take one baby aspirin (81mg) daily to reduce their risk of a heart attack. It is also recommend that all women between the ages of 55 and 79 take a baby aspirin to reduce their risk of a stroke. To support this decision, the USPSTF points toward evidence that men taking aspirin have a 32% decrease in their risk of having a heart attack and woman taking aspirin have a 17% decrease in their risk of having a stroke. Initially, this sounds pretty good, especially considering that you can go to your pharmacy and buy 300 aspirin tablets for less than five dollars. Unfortunately, there are dangers associated with taking aspirin.
Even taking aspirin in low dosages can increase your risk for bleeding in either your intestinal track or brain. Due to these potential harms, the US Food and Drug Administration has not approved the use of aspirin for use in men or woman who have never suffered a heart attack or stroke. They have also reviewed the evidence and believe that the potential for serious side effects outweigh the benefits.
There you have it, two completely different recommendations looking at the same evidence. The complicated issue is that no two people are alike. The risk of a 50 year old marathon runner, whose parents both lived to be 110 years old, having a heart attack is obviously much lower than that of a 50 year old couch potato whose parents both died from heart disease in their 50’s. One of the easiest ways to compare the risks and benefits of taking aspirin is to look at how often aspirin prevents a heart attack verses how often aspirin causes a major complication. These are statistical terms known as numbers needed to treat and harm. A 2009 article that reviewed all the previous studies indicated that 2,000 people need to take aspirin daily to prevent one heart attack. Additionally, the article showed that for every 3,333 people who take aspirin, one person will have a major bleeding event.
Things get more complicated when you start to look at people who have a higher risk of having a heart attack or stroke. This includes those with high blood pressure, diabetes, high cholesterol, family history of heart disease and tobacco use. Data clearly indicates that aspirin is more effective in men and woman who have a higher risk of heart attack and stroke.
So what are we to do? Unfortunately, like most things in medicine, there can be no one size fits all approach. You and your doctor should sit down and discuss your health and how aspirin can affect you.
Source: US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm.
Dr. Chris McCarty, DO, is a physician at St. Joseph Medical Group’s Family Medicine Elverson, 45 S. Pine Street, Elverson. For more information. call 610-208-4797.
