Do you Need to Take Daily Aspirin?

You might have believed that a daily low-dose aspirin intake was an effective way to avoid strokes, heart attacks and protect your heart health for many years.

Over time, however, multiple studies showed that this habit could cause serious complications, including an increased internal bleeding risk.

The risks of daily use of aspirin are being recognized in the new guidelines.

What are The Daily Aspirin Guidelines

These guidelines were published by the U.S. Preventive Services Task Force in fall 2021, a group comprised of preventive-focused medical specialists. The bottom line is that you shouldn't begin taking low levels of daily aspirin, sometimes referred to by baby aspirin.

No heart problems have ever occurred to you, including a stent and heart attacks. There is a greater risk of bleeding. If you're older than 60, and haven't stopped taking aspirin every day. Steven Nissen MD is a cardiologist and Chief Academic Officer at Sydell Family Heart Vascular & Thoracic Institute. "We know for at least a decade that the majority of people who never have had a cardiac event shouldn't take aspirin to prevent it," says Steven Nissen. These new guidelines will be closer to the recommendations that have been recommended by everyone for many years.

This isn't a new trend. Previous to this, doctors were less likely to recommend daily aspirin for preventive purposes.

2019 was also the year that American College of Cardiology/American Heart Association (ACC/AHA,) released revised guidelines. The guidelines recommended that aspirin should not be used to prevent heart disease in anyone over the age of 70, and in any other age group with an increased risk for bleeding.

How safe is it to use aspirin every day? Dr. Nissen says that aspirin should only be taken daily in very limited cases, such as if there is a history of heart disease, or if the risk of developing it, and after consulting your doctor.

He notes that aspirin should be avoided by most people because of the risk of bleeding. And bleeding may occur in the gastrointestinal tract, or even worse, the brain.

According to the U.S. Preventive Services Task Force, people aged 40-59 who have never had any heart problems should consult their physician about taking daily aspirin.

Dr. Nissen emphasizes that the age of an individual is not a good indicator for aspirin usage.

It's important to consider whether you have ever had a previous heart attack, stroke, or any preexisting issues with your heart, like coronary artery disease.

Dr. Nissen states that baby aspirin should not be considered a benign treatment. For patients with a history of a non-cardiovascular event, there has been ample evidence to show that aspirin daily can have as much risk as the benefits.

Is there any benefit?

Patients with heart disease must still be taking a low daily dose of aspirin. This is usually 81 mg. A normal dose of aspirin is 325 mg per pill.

Aspirin is anti-platelet and anti-clotting, so it may be beneficial to people with heart disease.

Dr. Nissen says that platelets are key to clotting. Because it blocks the platelets' ability to adhere together by a specific mechanism of stickinginess, aspirin can be a powerful anti-platelet drug. It's therefore useful for secondary prevention where there are high risks.

Aspirin Side Effects

A higher risk of bleeding is one of the worst side effects of aspirin. Studies have found a higher risk for hemorrhage from stroke or in the upper gastrointestinal tract.

Another study suggested that healthy older adults taking daily aspirin were at increased risk for death from any cause, including cancer.

In 2018, researchers published results of a five-year study involving nearly 20,000 healthy older adults over age 70 who either took 100 mg of aspirin each day or a placebo pill.

What was the result? The results were surprising: the aspirin-taking group had higher blood loss, but no cardiovascular benefit.

This was a high-quality study conducted as a randomized, double-blind, placebo-controlled trial, a method that keeps researchers themselves unaware about which patients have the placebo.

Do you need to take aspirin every day? It depends. The main thing is to determine if you have a high-risk heart condition. This could be due to factors such as high blood pressure, high cholesterol or being a smoker, diabetes, and previous medical history.

Dr. Nissen states that aspirin can be recommended for patients who have suffered a heart attack, stent or bypass surgery, and any other signs of coronary heart disease.

Should you discontinue taking aspirin if you've never had a heart attack but continue to take it every day? You'll have to decide. Dr. Nissen says, "In general I tell my patients that they should stop." But different doctors might have a different viewpoint. You might think that someone who has taken the medication for 10+ years, and is at very low risk of developing a gastrointestinal bleeding or brain bleed from it, should continue to take it.

It is not a good idea to stop or even start taking aspirin before consulting with your doctor. Dr. Nissen says that it is always a good idea to consult your doctor. Dr. Nissen says that medicine does not have a black-and-white approach and it is important to tailor your care. It is possible to discuss it together with your doctor. That is what we call shared decision making. "It's the right thing to always do."