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Aspirin is a very old drug but scientists are still trying to figure out if it should be used to prevent heart attacks and strokes. In April of 2016 the United States Preventive Services Task Force put out a recommendation regarding aspirin. These experts suggested that low-dose aspirin use could prevent heart attacks, strokes and colorectal cancer. The benefits were “modest” and there was a risk of bleeding. Then a study in The Lancet (July 12, 2018) analyzed data from 10 trials.  The authors concluded that low-dose aspirin was ineffective for people weighing more than 154 pounds. Now a new meta-analysis published in JAMA (Jan. 22, 2019) reviewed the results of 13 placebo-controlled trials with a total of more than 160,000 participants and over 1 million participant-years. The authors found that people taking aspirin were significantly less likely to suffer heart attacks, strokes or death from cardiovascular causes.

Aspirin For Your Heart? Should You or Shouldn’t You?

We cannot answer the above question on a global basis. And each individual will need to discuss this question with her primary care provider. That said, let’s drill down on the data. The JAMA study did an excellent job in providing absolute benefit and risk data. We only wish more research was presented this way.

The absolute risk reduction with aspirin was small, just 0.4 percent. How did the researchers come up that number? Please pay careful attention. This gets complicated.

The investigators analyzed the data for primary outcomes. Primary = death from cardiovascular causes, nonfatal heart attacks and nonfatal strokes. There were 3,072 such events in the no aspirin group and 2,911 events in the aspirin-taking group. That was an 11% reduction in events. But 265 people would have needed to take aspirin to prevent one event.

Here’s another way to think of this benefit. There were 61.4 events per 10,000 participant-years in the no aspirin group. There were 57.1 events per 10,000 participant-years in the aspirin group. That was a statistically significant reduction in cardiovascular events, but as you can see, not that impressive.

How Dangerous is Aspirin for your Heart?

The analysis also considered whether people taking aspirin were more likely to experience major bleeding. They were, although here too the difference was small, about 0.5 percent. The risk and benefit were almost evenly matched.

There were 23.1 major bleeding events per 10,000 participant-years in the aspirin-taking people and 16.4 serious bleeding events per 10,000 participant-years in the no-aspirin group.

Making Decisions About Aspirin for Your Heart:

The relatively small benefits and risks make a decision to use aspirin more complicated, especially for people without heart disease. The authors note:

“Consequently, the decision to use aspirin for primary prevention may need to be made on an individual basis, accounting for the patient’s risk of bleeding and their views on the balance of risk vs benefit.”

An editorial in the same issue of JAMA notes that:

“Because weighing the risks and benefits of aspirin in primary prevention is complicated, it should involve a shared decision-making discussion between the patient and the clinician.”

The bottom line seems to be that if your risk of a serious cardiovascular event is pretty high, low-dose aspirin could be modestly beneficial. If, on the other hand, your risk of bleeding is high, then the equation shifts against aspirin. Sorry…we warned you that it’s complicated. When it comes to aspirin there are no easy answers. You can read more about the benefits and risks of aspirin here.

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  1. Pat
    Austin
    Reply

    i had a TIA and couldn’t take low dose aspirin as it gives me dark bruises just
    leaning my arm over the back of my chair. My dentist said one low dose stays in the body all week. That works for me. I thought I’d try one midweek also, but here came the bruises.

  2. Bill B
    Katy, TX
    Reply

    There’s at least one confounding issue: the people who take aspirin every day are probably people who are more interested in their health than those who don’t. Does this account for the 0.4% difference. Does it account for even a larger difference? That is, aspirin has a negative effect that is masked by the more healthy overall habits of those taking it.

  3. JanieK
    WA
    Reply

    I am on coumadin and would like to switch to aspirin. Problem: Had a brain hemorrhage 39 years ago and had a new heart valve a few months ago. Coumadin caused hair loss and requires blood test every other week. I hate it. This is my conundrum.

  4. Dianne
    Houston
    Reply

    Are there any special considerations for someone who has had a stroke? Does Advil interact with aspirin?

  5. Paul T
    Dallas, TX
    Reply

    A third possibility exists. Take an aspirin occasionally when needed, as in maybe for high blood pressure, high tension, etc. All or nothing both seem to be extremes.

  6. Oded
    VA
    Reply

    The original aspirin study used a full dose aspirin every other day while these studies seem to be using low dose every day. It seems to me that the two protocols are very different. Why are they being conflated?

  7. Jack
    Whitsett NC
    Reply

    For one thing I break a standard 325mg aspirin in half to take twice a day which avoids all the coating needed on the 81. I’ve got varicose veins where clots have formed and caused inflamation in the past and I was only able to resolve this with this regiment. Also looking at potential anti-cancer benefits to the gut afforded by the aspirin my Dr. agrees. I know to drink plenty of water when taking one.

  8. Ellen C.
    d
    Reply

    I am concerned because my husband’s cardiovascular surgeon has him taking a baby aspirin every day plus plavix after having two stents placed last year. The risk for bleeding is higher
    and now he is taking iron because his iron count is low. That is a red flag to me but apparently not to his doctors.

  9. old man
    NC
    Reply

    A friend, retired professor of English, died from massive internal bleeding due to Aspirin. He was hospitalized overnight but by the time they got around to him, the patient had expired.
    I myself have been advised to take Aspirin, in spite of major gastro-intestinal side effects. But I made the decision to stop, against medical advice, to prevent life-threatening complications from the drug.

  10. Barbara
    Connecticut
    Reply

    According to my cardiologist, taking aspirin after age 70 does nothing to prevent heart attacks. I began the regimen when I turned 50 and finally gave it up at 74 when I heard the reports. I never had any bleeding problems. I considered this as one fewer poisonous pills in my body.

  11. Tom
    Greensboro
    Reply

    How strong is the data for reducing colon cancer when taking low dose ASA. If it’s still pertinent seems like a no brainer for most seniors to continue taking it.

  12. Roxie
    Washington State
    Reply

    I am confused by this article. In one part it says “The authors found that people taking aspirin were significantly less likely to suffer heart attacks, strokes or death from cardiovascular causes.”
    In another part it says “The absolute risk reduction with aspirin was small, just 0.4 percent.”

    Can this be clarified? To me, this is saying two pretty much opposite things. Thanks.

    • Joe Graedon
      Reply

      Roxie,

      Something can be statistically significant but small. You might be surprised to learn that many drugs are approved because the benefit was “significantly” better than placebo in a clinical trial. That is to say, statistically significant…but not very much better than placebo.

      Let’s take a famous Lipitor clinical trial as an example. The company advertised Lipitor as lowering the risk of a heart attack by 36% over five years in a high-risk population. The absolute risk reduction was small, however. Three people out of a hundred had a heart attack while taking placebo. Two people out of a hundred had a heart attack while take Lipitor. That means that one person out of 100 got benefit over five years.

  13. Carol
    Houston
    Reply

    I take Synthroid for low thyroid and have bloodwork done yearly. My doctor noted slightly elevated blood pressure and prescribed Atacand. 2 years later while in for my yearly thyroid checkup, I mentioned to the doctor that I was experiencing extreme shortness of breath and some dizziness if I had to physically rush. As I was traveling every week, this was frequent.

    He ran an EKG, noted heart issues. Sent me to a heart clinic. I could not go for 3 weeks, and in the meantime after reading about Atacand, stop taking it. Heart doctors could find no issues with the heart, and my shortness of breath had disappeared. But they recommended I take a baby aspirin daily. I did for 2 years until 2013 when I passed out on a plane throwing up blood, met by ambulance, taken to hospital and received blood transfusions. No prior indication that I would have a bleeding issue. So beware. Medicine is not always the solution.

  14. Chris
    North Carolina
    Reply

    According to the new meta-analysis study, did the modest benefits go away if someone was over 154 lbs?

    • Terry Graedon
      Reply

      We don’t know. Perhaps that is why the benefit was so modest (Lots of people weigh more than 154 lbs).

  15. Eugene Joseph M.
    QC
    Reply

    Few if anybody would take big pharma nostrums if effectiveness were quoted in NNT or percentages rendered in absolute terms. Hence the use of mumbo jumbo statistics.

  16. Robert M
    Florida
    Reply

    I understand that aspirin “thins” your blood. So does Warfarin and a newer drug Eliquis. I have seen data comparing those which seemed to show Aspirin wasn’t quite as effective as the other two, but still did do the job to a degree. Comments? Specific question: It used to be that it was recommended if you felt you were having a heart attack or stroke, you should take several aspirin while waiting for an ambulance. Is that still a legitimate suggestion? Thanks for the article.

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