Is An Asprin A Day Still A Good Idea?

Millions of people take aspirin every day to lower their heart attack and stroke risk, but research may change some of that thinking.

Daily aspirin use was associated with a higher-than-expected increase in the risk for major bleeding in a study published in the Journal of the American Medical Association.

The risk for serious bleeds was five times higher than has been reported in clinical trials of daily low-dose aspirin, says researcher Antonio Nicolucci, MD.

He noted that while daily aspirin therapy has been proven to lower the risk for a second heart attack or stroke in people who have already suffered one, the treatment's usefulness for preventing a first heart attack or stroke is not so clear.

"People with a moderate-to-high risk for having a major cardiovascular event probably benefit from aspirin therapy, but the risks may outweigh the benefits for people with a lower risk," Nicolucci says.

Diabetes Linked to Bleeding Risk

Researchers were surprised to find that patients with diabetes had a 36% increased risk for these potentially life-threatening bleeding episodes even when they did not take aspirin. Aspirin use did not appear to influence this risk for people with diabetes in one way or another.

Diabetes is a major risk factor for heart attack and stroke, and low-dose aspirin is recommended for most diabetic men over age 50 and diabetic women over 60 when other heart disease and stroke risk factors are present.

American Heart Association past president Robert Eckel, MD, says more study is needed to understand the impact of diabetes on bleeding risk.

Statins May Lower Bleeding Risk

The study also suggested a protective role for cholesterol-lowering statin drugs against bleeding.

Taking statins was associated with a lower risk for both gastrointestinal and brain bleeding.

Nicolucci says the study's findings highlight the importance of considering an individual patient's cardiovascular and bleeding risk when aspirin therapy is being considered.

"Many things influence bleeding risk, including the use of anti-inflammatory pain drugs, other drugs, and even alcohol and smoking," he says.

Taking aspirin safely

Dosage: Follow the recommended dosage instructions provided by your healthcare provider or on the medication label. Aspirin comes in various strengths, so make sure you're using the right one.
Purpose: Aspirin is commonly used to relieve pain, reduce fever, and help manage inflammation. It's also used in low doses to prevent blood clotting. Make sure you're using it for the intended purpose and not exceeding the recommended dose.
Take with Food or Water: Taking aspirin with food or water can help reduce the likelihood of stomach irritation or upset.
Avoid Alcohol: Alcohol can increase the risk of stomach bleeding when taken with aspirin. It's best to avoid alcohol while using aspirin.
Allergies and Sensitivities: If you're allergic to aspirin or any other nonsteroidal anti-inflammatory drugs (NSAIDs), or if you've had adverse reactions to them in the past, you should avoid using aspirin.
Medical Conditions: Inform your healthcare provider about any medical conditions you have, especially if you have a history of stomach ulcers, bleeding disorders, kidney problems, or other health issues. They can advise you on whether aspirin is safe for you.
Interactions: Aspirin can interact with other medications, including over-the-counter and prescription drugs. Make sure to inform your healthcare provider about all the medications you're taking to avoid potential interactions.
Don't Crush or Chew: Swallow aspirin tablets whole. Avoid crushing, chewing, or breaking them unless directed to do so by your healthcare provider.
Pregnancy and Breastfeeding: Consult your doctor before using aspirin if you're pregnant or breastfeeding, as it may not be suitable in certain situations.
Storage: Store aspirin in a cool, dry place, away from direct sunlight and out of reach of children.
Bleeding Risk: Aspirin can increase the risk of bleeding, so it's important to be cautious if you're taking other blood-thinning medications or if you're scheduled for surgery. Your healthcare provider should be aware of all your medications.
Side Effects: Common side effects of aspirin can include stomach upset, heartburn, and mild stomach pain. If you experience severe side effects, such as difficulty breathing, allergic reactions, or signs of bleeding (like bloody or tarry stools), seek medical attention immediately.

Don’t take aspirin just because you’ve heard it can help prevent a heart attack or stroke. It can, but it can also do some damage. If you are healthy, haven’t been diagnosed with heart disease or other cardiovascular disease, and don’t have risk factors for them, aspirin probably isn’t for you. You’ll reap little benefit while exposing yourself to side effects you’d rather stay away from. The less healthy your heart and arteries, the more likely the advantages of taking aspirin will outweigh any risks.