Go Ad-Free
logoThe People's Perspective on Medicine

Aspirin Strikes Out for Preventing Heart Attacks

Aspirin can work for preventing heart attacks, but it can also cause excessive bleeding. People need to weigh the benefits and risks before taking it long-term.

Low-dose aspirin has been a staple of heart disease prevention for decades. However, although data have indicated that people taking aspirin are less likely to have heart attacks, they appear more likely to suffer from serious bleeding. Do the benefits of preventing heart attacks outweigh the risks of hemorrhage?

Does Aspirin Work for Preventing Heart Attacks?

New studies presented at the European Society of Cardiology suggest that the balance of benefit and risk might be too close to call for many people. In one of these trials, people at risk for a heart attack because they smoked or had high cholesterol or hypertension took 100 mg of aspirin or a look-alike placebo pill every day for about five years (The Lancet, Aug. 26, 2018). By the end of that time, 4.29 percent of those on aspirin had experienced a heart attack, stroke, unstable angina or death due to cardiovascular causes. That was slightly fewer than the 4.48 percent of people taking a placebo. On the other hand, more (0.97 percent) of the people on aspirin had a gastrointestinal bleed, compared to 0.46 percent of those on placebo. About the same proportion of people in each group experienced a serious adverse event, 20.19 percent on aspirin and 20.89 percent on placebo.

The investigators observed that there were far fewer heart attacks and strokes in both groups than they had anticipated. That means the trial really doesn’t tell us much, if anything, about how well aspirin works for people at moderate to high risk. Instead, it confirmed previous research that for people at low risk of a first heart attack, aspirin doesn’t provide enough benefit to make it worth the chance of a bleed.

Can People with Diabetes Take Aspirin for Preventing Heart Attacks?

The other trial included people with diabetes, a condition that puts them at higher risk for heart disease and strokes (New England Journal of Medicine, Aug. 26, 2018). More than 15,000 people in this randomized trial took aspirin or placebo. They also took either fish oil or an olive oil placebo. As a result, some people got both “active interventions,” some got one plus a placebo, and some got two placebos. The study lasted more than seven years.

The outcome: aspirin was helpful in preventing heart attacks and strokes, but it also triggered hemorrhages. About 4 percent of those taking it had a bleeding event. For comparison, approximately 3 percent of those taking placebo experienced a hemorrhage.

The investigators write:

“The absolute benefits were largely counterbalanced by the bleeding hazard.”

What Should You Do?

If you are currently taking low-dose aspirin (81 mg in the US) for preventing heart attacks, talk with your doctor. The two of you should consider your baseline risk for heart attacks and strokes. You will also want to evaluate your risk for a dangerous bleed. For most people at low risk of cardiovascular complications, aspirin may not be worthwhile. But those who are most susceptible to such problems may still benefit.

Rate this article
5- 22 ratings
About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
Tired of the ads on our website?

Now you can browse our website completely ad-free for just $5 / month. Stay up to date on breaking health news and support our work without the distraction of advertisements.

Browse our website ad-free
Join over 150,000 Subscribers at The People's Pharmacy

We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.