"The groundwork of all happiness is health." - Leigh Hunt

Advice on day by day aspirin

Should you’re taking this anticoagulant to forestall a heart attack or stroke?

Aspirin Aspirin

In the early Eighties, greater than 22,000 male physicians with no history of heart disease or stroke volunteered for what became a landmark trial, the Physicians' Health Study. For five years, they took either 325 milligrams (mg) of aspirin or a placebo every other day. Over five years, those taking aspirin had 44 percent fewer heart attacks than those taking a placebo.

But there have been some downsides, including more bleeding ulcers and a rather increased risk of bleeding within the brain in aspirin users. A later study found that even low-dose aspirin (81 mg) could cause gastrointestinal bleeding, especially in people 65 years of age and older. Compared to ischemic strokes (attributable to clots), hemorrhagic strokes (attributable to bleeding) are much less common, accounting for less than 13 percent of all strokes. But aspirin use increases the danger of hemorrhagic stroke, especially in individuals with hypertension.

Today, half of Americans age 45 and older take low-dose aspirin day by day. For a few of them, it's a superb idea. Others should consider stopping, because the risks likely outweigh the advantages. But many fall somewhere in the center. Here's the most recent information on who should consider — and who should avoid — aspirin to forestall heart attack and stroke (see “An Aspirin Algorithm” for a summary).

Remember: Even in the event you're within the “yes” category — and particularly in the event you fall under the “maybe” category — don't take (or take) day by day aspirin without first talking to your doctor. Close).

An aspirin algorithm

This table provides a fast summary of current advice about aspirin. See most important story for more details.



Ischemic risk

Start low-dose aspirin?





Primary (stopping the primary heart attack or stroke)

Imaged vascular disease








Risk of excessive bleeding



Above 70 years

less or more

possibly not.

Yes: People who’ve already had a heart attack or stroke as a consequence of a blood clot (ischemic stroke). For these people, a day by day aspirin often is sensible. This practice, often known as secondary prevention, applies to anyone who has atherosclerotic heart problems (ASCVD). This includes all conditions attributable to plaque buildup (atherosclerosis) anywhere within the body—not only heart attacks and ischemic strokes, but in addition transient ischemic attacks (TIAs, or ministrokes), angina (chest pain from narrowed arteries in the center). pain), and peripheral artery disease. (Plaque within the leg arteries) Anyone who has had coronary bypass surgery or had a stent placed to revive blood flow to the center can be considered to have ASCVD.

May: People with evidence of ASCVD on imaging tests. This group of individuals includes those that are at high risk for a heart-related problem based on visual evidence of plaque of their arteries. Tests include a coronary artery calcium scan, a CT scan done for one more reason (equivalent to screening for lung cancer or pulmonary embolism), or an ultrasound of the arteries within the neck (carotid ultrasound). Dr. Cannon cautions that there aren’t any large studies showing that aspirin helps these people. The profit likely outweighs the danger, he added, however the calculation will depend upon your individual situation.

Can: People with diabetes. In general, people ages 40 to 70 with diabetes who’re at high risk for heart disease should consider low-dose aspirin. You can estimate your 10-year risk of ASCVD with this calculator created by the American Heart Association and the American College of Cardiology (find it at /heartrisk). High risk is defined as a 10-year risk of 20% or more.

May: People are in danger for each clotting and bleeding. For essentially the most part, people without ASCVD prone to bleeding mustn’t take day by day aspirin. This includes anyone with a history of bleeding into the stomach or elsewhere within the body (for instance, severe nosebleeds or blood within the urine); Stomach ulcer (peptic ulcer disease); low blood platelets (thrombocytopenia); blood clotting disorder (coagulopathy); and other people who take nonsteroidal anti-inflammatory drugs (NSAIDs) repeatedly, equivalent to those with arthritis or other painful inflammatory conditions. An exception is those with a 10-year ASCVD risk rating of 20% or higher, in whom cardiovascular risk may outweigh bleeding risk. Taking a proton pump inhibitor equivalent to omeprazole (Prilosec) with aspirin can assist reduce the possibility of gastrointestinal bleeding, Dr. Cannon says.

Probably not: Anyone over 70 without ASCVD. Because the danger of bleeding increases with age, most individuals over age 70 without ASCVD (see category 1 above) mustn’t take day by day aspirin. A newer study found no significant profit in people over 70 but an increased risk of bleeding. If you began taking aspirin in middle age, it was a superb idea back then. But when you reach 70, the danger of bleeding from day by day aspirin may outweigh any protection against heart attack or stroke, so you need to check along with your doctor in the event you should proceed. Should be kept.

Photo: © Creatas/Getty Images