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 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.
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.