Aspirin To Prevent Heart Attacks

Many people know that aspirin can prevent heart attacks and strokes.  In the past aspirin has been recommended for people with known clogging or atherosclerosis of the arteries.   Certainly it has been shown to prevent second heart attacks after someone has already had a heart attack.  In March  2009 however there was a significant change in the recommendations for the use of aspirin.  The current guidelines now clearly recommend the use of aspirin to prevent a first heart attack.  Not just after the first event.  This applies to men from ages 45 to 79 and in women ages 55 to 79.  There isn’t enough evidence to recommend aspirin for people older than 80.  This guideline may be a surprise to many people.  Aspirin has been used to prevent heart attacks for years in people of many ages.  Formal guidelines did not support recommending aspirin in lower risk groups prior to March 2009. Nonetheless it has been used that way for many years safely by patients and physicians alike.   

You may ask so why the change? Cardiovascular disease (heart attacks and strokes) causes 58% of all deaths in the United States.    It is the leading cause of death.  The lifetime risk of having cardiovascular problems for men is high. Two out of every three men will have problems.  For women the risk is, one of every two women.  In the past it has been difficult to show that the risks of aspirin use in lower risk groups outweighs the benefits.  Everything we do has risks, including eating the extra spicy chili from Uncle Ralph.   Many of us will still choose Uncle Ralph’s chili, the risk is acceptable.  The risk of aspirin use involves a slightly higher risk of bleeding.  This may occur for example in the stomach, skin (bruising) or nose.   However just because a risk can occur, doesn’t mean it will occur.  Many people take aspirin and may have only a little nuisance bruising, not enough that bothers them.  Aspirin prevents heart attacks and strokes by making the blood less sticky.  So this means that bleeding occurs more easily, but that is what it is supposed to do.  That is how blockages in the heart and brain are prevented.  So the new recommendations have carefully balanced the risks and benefits to give people solid advice based all the risks and benefits.  Getting a bunch of experts to agree is sometimes not an easy task.  It is big news when a group agrees on a new guideline.

The guidelines do not recommend the use of aspirin in people over 80 because the benefits do not clearly out weigh the risks.  But remember not every 80 year old is the same.  Some 80 year olds are more like a 60 year old. Sometimes it’s the miles not the years.  Doing studies on people older than 80 isn’t easy, so that makes it harder to come up with good solid safe recommendations.  This is an area where the decision to use aspirin must be made between a physician and their patient.  It doesn’t mean that aspirin shouldn’t be used.

Most men younger than 45 and women younger than 55 are relatively healthy.  They won’t have a significant benefit from aspirin use.   So there is no reason to recommend aspirin.  However there are people that despite being young may benefit from aspirin because of certain diseases. Anyone that is young but with type two diabetes or if they have already had a heart attack or stroke may benefit from aspirin.  These people should talk to their doctor or other health care provider to decide is aspirin is a good idea.

The dose of aspirin that helps is 81mg; higher doses however are sometimes recommended.

Annals of Internal Medicine in March 2009 (Ann Intern Med 2009;150:396-404).

U.S. Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm