Daily Aspirin — Still the Best Way to Stay Healthy?
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
You may have read articles or heard news reports with new information about the effectiveness of daily aspirin. Pharmacists like me are getting questions about it routinely since new research results were published last year. Millions of adults take aspirin daily to prevent stroke and heart attack. Some started taking it on their own after hearing about its benefits; others started at the recommendation of their health care provider.
And it's true - we've known for decades that aspirin really does decrease the risk of heart attack and stroke for many people. They're more likely to live longer and less likely to have disabilities that affect their daily lives. That part hasn't changed. But the new research suggests that aspirin may not provide protection for everyone. And others may have such a high risk of side effects that the dangers outweigh the benefits.
Aspirin works by making blood platelets less "sticky". That means it's less likely that tiny clots will form and block a blood vessel, causing a stroke or heart attack. But it turns out that decreasing the blood's ability to clot is also the cause of most of aspirin's side effects. People who take aspirin routinely often experience annoying bruises, and more bleeding than usual if they suffer a minor injury. But the worst side effects - the ones we'll be talking about later - are more severe episodes of bleeding, like stomach and intestinal bleeding and bleeding in the brain.
Over the past few decades, many groups of people were thought to benefit from daily aspirin. Aspirin was recommended for those who'd already suffered a heart attack or stroke or had someone in their family of origin with a heart attack or stroke. It was also recommended for people who didn't have a personal or family history, but had certain risk factors (diabetes, for example). People in these groups would often start taking aspirin in middle age, and continue on it for the rest of their lives.
The new information that came out recently tells us that aspirin may actually do more harm than good in certain people. One of the groups studied included people 65-70 years of age or older with no personal history of heart attack or stroke. Nearly 20,000 people (half of whom took aspirin while half didn't) were followed for almost five years. In the end, aspirin had little protective effect on heart attack or stroke, but caused a large increase in the risk of major bleeding.
Another study looked at a group of people with diabetes (a major risk factor for heart disease) who were at least 40 years old. They'd never had a heart attack or stroke and had no evidence of heart disease. For about 7 1/2 years, half of the group took aspirin while the other half didn't. It was found that who took aspirin actually did have a slight decrease in their risk of heart attack or stroke. The problem was that they also suffered a significant increase in the risk of major bleeding. The researchers concluded that the benefits of daily aspirin in this group didn't outweigh the risks.
The third group studied was in people age 55 (men) to 60 (women) and older who'd never had a heart attack or stroke. Over five years, the incidence of heart attack and stroke was slightly lower in those who took aspirin, but the incidence of bleeding in the stomach and intestinal tract was higher. So, again, these researchers concluded that in this group, the benefits of daily aspirin were outweighed by its dangers.
If you're one of the many people who take a daily aspirin, you may be wondering if you should continue doing so. Here are some questions that may help you decide:
Have you ever had a heart attack or stroke? Have you needed a procedure to prevent you from having a heart attack or stroke (stent placement, for example)? Is your doctor treating you for some other form of heart disease? If the answer to any of these is "yes", you may be one of the many people who REALLY DO benefit from daily aspirin. That doesn't mean your'e not at risk for side effects, so be on the alert for unusual bleeding. But the likelihood is that the health benefits of daily aspirin are much greater than the possible dangers.
Think back to when you started to take aspirin -- did you decide to take it on your own or did your doctor recommend it? If your doctor suggested it, there may be something in your medical history that suggests you're likely to benefit from daily aspirin. Talk with your doctor about this new information to learn whether you should continue taking aspirin or not.
Most important, though, is that you and your doctor make a plan together to keep you as healthy as possible. Your pharmacist can help by providing you with the best information about medicine, including non-prescription medicines like aspirin, so that you can have a productive conversation with your doctor.
There's always new information coming out about the best use of medicines. Your pharmacist can help you understand how new information applies to your situation. Then, you and your doctor can use the new information to personalize your health care and make it work for you. Start a conversation by commenting below, or contact us at BetterMyMeds to ask a question or schedule a consultation!