In recent years, a series of studies have called into question the use of low-dose aspirin as a prophylactic treatment for heart attacks and stroke. Although the perception of the benefits of aspirin seems simple, there is in fact a complex discussion to be had regarding its usage on a preventative basis. To learn more, we reached out to Dr. Kirsten Healy at New York Cardiology Associates and attending cardiologist at New York Presbyterian Hospital / Weill Cornell Medical Center. Dr. Healy, who has presented at numerous national conferences and is the Associate Medical Director of The Foundation for Gender-Specific Medicine, recently took the time to provide some expert insight for the Priority Private Care community as follows:
Daily aspirin therapy may lower your risk of a heart attack or stroke, but is it right for me?“Almost 200 years ago, acetylsalicyclic acid was developed and trademarked as aspirin. Aspirin is well known to be a remarkable anti-inflammatory and anti-thrombotic agent. It is one of the oldest and most widely used drugs in history.
Aspirin therapy has been well established for secondary prevention of cardiovascular disease. However, its role in primary prevention is much more controversial, especially in older patients with an increased risk of bleeding. This controversy has been brought to light with recent studies that have suggested that, in some patients, there is no benefit to using aspirin. In fact, it may cause increased risk of morbidity and mortality.
How does aspirin work to prevent a heart attack?
Aspirin interferes with the body’s blood clotting action. When bleeding occurs, platelets (the blood clotting cells) build up at the site of the wound. The platelets help form a plug that seals the opening in the blood vessel to stop the bleeding. This clotting mechanism can also happen within the vessels of the heart. If the blood vessels are narrowed from atherosclerosis, fatty deposits, or plaque, the vessel lining can rupture. This rupture causes a blood clot to form and consequentially block the artery. This will prevent blood flow to the heart and cause chest pain and, most likely, a heart attack. Daily aspirin therapy reduces the clumping action of platelets, possibly preventing a heart attack from occurring but at the same time, decreasing the body’s ability to clot in other areas, if there is damage.
Should I take a daily aspirin?
There is no indication to take a daily aspirin for the primary prevention of heart disease, as evidence by recent studies in the New England Journal of Medicine, which showed an increased risk of complications when aspirin was used for primary prevention. In one study over 12,000 healthy patients with no history of heart disease were randomized to either 100 mg of aspirin or placebo. Overall after five years of following these patients, the trial did not show significant benefit for aspirin, though there were significant increases in gastrointestinal bleeding. There were no significant differences in the rate of heart attack, stroke or death. Primary prevention is concerned with preventing the onset of disease. It aims to reduce the incidence of the disease, and it involves interventions that are applied before there is any evidence of disease or injury. Secondary prevention, on the other hand, refers to the prevention or recurrence of a cardiovascular event or complications in people who have already been diagnosed with cardiovascular disease. Aspirin is absolutely indicated if a) you have already had a heart attack or stroke b) you haven’t had a heart attack, but you have had a stent placed in one or more of the coronary arteries c) you have had coronary artery bypass surgery d) you have chest pain due to coronary artery disease e) you have significant calcium or calcium and plaque found on cardiovascular screening. Aspirin can be strongly considered in patients who have never had a heart attack, but have multiple risk factors, suggesting that they are at high risk for one, as well as patient who have diabetes and other heart disease risk factors, such as smoking or high blood pressure.
How much aspirin should I take?
This dosage should be discussed with your doctor. If you have had a heart attack or a stent, it is extremely important to take aspirin and/or other blood thinning medications exactly as recommended by your physician. Very low doses, such as 75 mg. to 150 mg., and most commonly, 81 mg., are usually effective.
What are the side-effects of daily aspirin therapy?
- Stroke: Although a daily aspirin can prevent a clot-related stroke, it can increase the risk of a hemorrhagic stroke, which is a stroke caused by a bleed.
- Gastrointestinal Bleeding: Daily aspirin use increases your risk of developing a stomach ulcer and gastrointestinal bleeding.
- Allergic Reaction: If you have any allergy to aspirin, taking any dosage can trigger a reaction.
What else can be done for primary prevention of cardiovascular disease?
In the past, aspirin has been recommended as a cornerstone for primary prevention of cardiovascular disease. However, in modern medicine, risk factors for cardiovascular disease have been better controlled by newer medications. There are many options to treat hypertension, and keeping the blood pressure in a normal range can decrease the risk of a cardiovascular event. Most importantly, the development over the past 30 years of statin therapy has perhaps been the most effective way to prevent cardiovascular disease. This has been well established in many studies. In many ways, statin therapy has decreased the importance of aspirin therapy in the prevention of heart disease as statins have proven to be much more effective than aspirin in the primary prevention of heart disease.”