Should I Take Aspirin To Prevent A Heart Attack?

For years, aspirin was touted as a wonder drug that could help prevent heart attacks and strokes. But research has found that the benefits of low-dose aspirin might not exceed the health risks for everyone.

For decades, millions of Americans popped a low-dose or "baby aspirin" each day to lower their heart risks.

Then, data prompted the nation's two leading cardiology groups -- the American College of Cardiology and the American Heart Association -- to overturn advisories in 2019 and recommend against daily aspirin, citing a risk for bleeding that exceeded any benefit for most people.

Trouble is, many Americans aren't heeding that message and continue to take the daily pill, a study in the Annals of Internal Medicine shows. The data found that by 2021, almost 30% of Americans ages 60 or older were still taking one every day. But because risks from daily aspirin might exceed benefits, experts urge that patients discuss whether they should take aspirin to prevent heart attacks.

Learn when experts recommend you should and shouldn't take aspirin to prevent a heart attack.

Why Is Aspirin No Longer Recommended To Prevent Heart Attacks?

Current advice from the American Heart Association states that "because of the risk of bleeding, aspirin therapy is not recommended if you have never had a heart attack or stroke, except for certain select people."

The heart association now advises discussing your suitability for aspirin therapy first with your doctor, especially if you're over 70.

"If you’re over 70, taking aspirin to prevent a first heart attack or stroke could do more harm than good," the heart association said.

The change reflects new data showing that daily aspirin does little to prevent a first heart attack or stroke, but it does greatly increase the risk of bleeding.

The updated US Preventive Services Task Force guidelines recommend against low-dose aspirin use to prevent cardiovascular disease for people 60 and older.

The choice for people between 40 and 59 would be between themselves and their doctor, but the task force warned that the “net benefit of aspirin use in this group is small.”

The guidelines did not change for people taking aspirin to prevent a second heart attack.

How Does Aspirin Help Prevent Heart Attack and Stroke?

“The aspirin is an anti-platelet agent,” said Faheem Ahmad, MD, a Crown Point cardiologist with Franciscan Physician Network. “Imagine the blood vessels in your body, and inside the lining of the blood vessels is plaque that is building up over time. As this plague grows and becomes inflamed, the plaque breaks open. When this happens, the body reacts in several ways.”

First, the body tries to fix that plaque that just broke open by sending platelets to the area. But as the platelets try to mend the plaque mass, they block the blood vessel and disrupt blood flow. If the blocked blood vessel is in or near the brain, it can cause a stroke if it’s in the heart, a heart attack.

The blood-thinning features of aspirin are thought intercede in this process.

“Aspirin decreases that downstream effect of ruptured plaque,” said Dr. Ahmad.

But while aspirin can help prevent blood clots from clogging arteries and causing a heart attack or stroke in some patients, heart experts have constantly weighed that benefit against the risk of internal bleeding, even when taken in a low-dose form, between 81 and 100 milligrams.

New data suggest that “the increased risk of bleeding associated with aspirin use occurs relatively quickly after initiating aspirin,” with the absolute risk of bleeding increasing with age, the US Preventive Services Task Force said.

Who Should Be Taking Aspirin to Prevent Heart Attacks?

“This is perhaps the most critical question we have: “Who are the right people for aspirin therapy?” said Dr. Ahmad. “First, let’s identify those patients we know are going to benefit: patients who’ve already had a heart attack or a stroke, or already have evidence of significant plaque. Whether it be the carotid artery or blood vessels in the legs—known as peripheral arterial disease—those patients would certainly benefit from a daily low-dose aspirin. The data here is fairly cut and dry. But where the real question is, is it a good preventive care choice for patients—that’s where we have our questions.”

For adults under 60, a heart scan may be able to predict who may benefit most from aspirin therapy, Dr. Ahmad said.

“Data is showing us that this is a very promising approach,” he said. “When someone has significant calcium in the blood vessels of the heart, we take a calcium score. And if that’s greater than 100, which falls in the moderate risk category, then that patient may benefit from aspirin therapy.”

HealthDay News contributed information to this article.