The aspirin quandary

An aspirin a day is supposed to keep heart attacks away… or does it?

A growing body of research is casting doubt on the longstanding belief that daily low-dose aspirin can help prevent heart problems in people who are otherwise healthy. The latest evidence comes from a study published earlier this month in the Archives of Internal Medicine, which analyzed nine studies involving more than 102,000 American adults and concluded that for many people, daily aspirin is unlikely to be beneficial and might even be harmful.

Talk about putting the common wisdom in a whole new light.

This particular issue resonates with me in a very personal way. I have high blood pressure, which is a known cardiovascular risk, and I’m currently in a quandary over aspirin use. Should I take it daily or not? Would it help or would it hurt? My doctor has suggested it (although he hasn’t pushed it and he’s been up front about the lack of a clearly established benefit for primary prevention of a cardiovascular event) but I’m struggling to decide.

For me, the study in the Archives of Internal Medicine arrived at an opportune time. Among the take-home points I gleaned: The rate of fatal heart attacks and strokes was essentially the same among people who took daily low-dose aspirin as those who didn’t. Those who took aspirin each day did have a 10 percent lower risk of heart disease but this was fueled mainly by a reduction in fatal heart attacks. There were no differences between men and women.

Of note, those who took daily aspirin had a 70 percent higher chance overall of problems with bleeding due to aspirin’s tendency to thin the blood. The risk of serious bleeding was 30 percent higher for the aspirin-takers than for those who didn’t take daily aspirin.

Another way of viewing the odds: For every two cases of heart disease or stroke prevented by daily aspirin use, there were more than three cases of serious bleeding. Overall, about 162 healthy adults would have to take aspirin each day for six years in order to avoid just one non-fatal heart attack, the researchers wrote.

Given these statistics, is it time for the health community to stop making a blanket recommendation for every American adult – even those at only moderate risk of heart disease – to take daily aspirin?

I think we’re beginning to see a shift in how prevention and medical intervention are discussed. At one time the emphasis was on taking action, even if the risks and/or benefits weren’t entirely clear. If there was a chance that aspirin or antibiotics or a CT scan it would help, it was worth it – or so the thinking went.

In recent years a new element has crept into the conversation. There seems to be a greater willingness, by clinicians as well as the public, to question whether a given intervention will truly help the patient. There’s more awareness that medical action also entails some risk, and that the risk may be higher for some people than for others.

Unfortunately, it also has brought more nuance and more confusion into the decision-making process. If daily aspirin use is beneficial to a subset of people, who are they and does this group include me? How do I weigh the risk vs. the benefit in the context of my own health and cardiovascular risk factors?

I’ve gone so far as to buy a bottle of low-dose aspirin. It’s sitting in the medicine cabinet but remains unopened. I’m still mulling over all the studies and just can’t make up my mind.


2 thoughts on “The aspirin quandary

    • Nine earlier studies were analyzed for the AIM article. Although they were all separate studies and hence not entirely identical in design, most of them involved daily aspirin at 100 mg or lower vs. a placebo among healthy individuals.

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