Is an aspirin a day right for you?

Last year, my younger brother turned 56, gained a few pounds. His blood pressure was up. Diabetes runs in our family. He started taking a baby aspirin a day because he read somewhere it’s good for his heart.

At the time, I thought nothing of it. What harm can a baby aspirin a day do? But after reading the draft of the U.S. Preventive Services Task Force’s (USPSTF) new guidelines on aspirin, I’m having second thoughts.

For almost a century, cardiovascular disease, mostly heart attacks and strokes, has been the leading cause of deaths in the U.S. It accounts for one in three deaths.   

Those who suffer one event are at high risk of having a second one. Study after study showed that aspirin can significantly reduce the chance of a second heart attack or stroke. Aspirin works by reducing inflammation and, more importantly, impairing blood clot formation. It’s so effective that low-dose or baby aspirin (81 mg) works just fine.

In 2002, the American Heart Association began to endorse using low-dose aspirin to reduce first heart attacks and strokes for at-risk people (I’ll explain later how doctors determine risk).

But they’re problems in paradise; aspirin is very safe, but not risk-free. The big elephant is bleeding – especially brain and gastrointestinal track (e.g., stomach ulcers). Although rare, it can result in transfusion, hospitalization, and death.   

Enteric-coated aspirin costs more but does not protect us from ulcers or bleeding. These side effects don’t depend on how or where the pills are digested; they result from the actual chemical that circulates in the blood.

In the new USPSTF draft, what stays the same? If you don’t have cardiovascular diseases and are between the age of 40 and 60, you could discuss starting aspirin with your physician.

What’s different? If you’re over 60, the USPSTF experts are against using aspirin to prevent a first heart attack or stroke.

My takeaways:  

1. If you have had cardiovascular disease or something that prompted your doctor to start you on aspirin, please stay on it. This guideline does not apply to you.
2. If you’re between 40 and 60, your neighbor just had a five-vessel bypass, and now you’re thinking about aspirin, talk to your doctor. To qualify, you need to have a high risk of developing heart disease and a low risk of bleeding. First, doctors will estimate your heart attack risk by using a validated calculator, then they’ll determine your risk of bleeding. Only then will you have enough information to decide.
3. If you’re over 60, aspirin is not a good choice. You’re better off working with your doctor to optimize your cholesterol and blood pressure. Also quit smoking, eat better, exercise more, and – here’s one thing we don’t talk enough about – lower your stress.  
4. Finally, most people don’t know that aspirin is handled carefully before surgery. Because one dose can cripple proper clotting for days to a week, remember to disclose any aspirin intake to your dentist, surgeon, and anesthesiologist.

I called my brother. His calculated heart risk is low which precludes much benefit from aspirin. Great news. He said after taking aspirin for a few months, he stopped it anyway.

So much for free medical advice.