Women of all ages often ask if they should be taking a daily low-dose (81 mg) of aspirin to improve their heart health. Well, yes and no, depending on your age. Mayo Clinic cardiologist Dr. Sharonne Hayes, founder and director of the Mayo Women’s Heart Clinic, explains:
“Guidelines urge women to be more aggressive about cutting their heart disease and stroke risks. One of the common recommendations is for women over 65 years of age to consider daily aspirin therapy.
“The aspirin recommendation comes out of the ongoing Women’s Health Initiative study, the largest study of heart disease risk factors in women. In 2005, the WHI group released a study showing that the most consistent benefit of aspirin for heart attack prevention was observed among women 65 years of age or older. Women in this age group who took aspirin had nearly one-third fewer cardiovascular events (heart attack and stroke) than did women who took a placebo. However, the women taking aspirin had more gastrointestinal bleeding as well.
“The key word in these guidelines is ‘consider’. The guidelines recommend that women ‘consider’ taking aspirin – which means have a discussion with your doctor about the risks and benefits of taking aspirin based on your own individual stroke and heart attack risks.
“The higher your risk of heart attack or stroke, the more that risk is reduced by taking aspirin, but the higher your risk is of bleeding. So it’s a balance each woman needs to discuss with her physician.”
Amazingly, it may have been a simple typo in the British Medical Journal back in 2002 that started this idea that taking an aspirin every day would be good for us.
Dr. Colin Baigent, author of a 2002 study on aspirin therapy published in the BMJ, said during a later HeartWire interview (December 2009):
“In the original print edition of the BMJ paper, the final sentence reads: ‘For most healthy individuals, however, for whom the risk of a vascular event is likely to be substantially less than 1% a year, daily aspirin may well be appropriate.’
Trouble was, that last word “appropriate” was wrong. A correction swiftly issued by the BMJ noted that final word should, in fact, be “inappropriate”.
Dr. Baigent says he received “a profuse apology from the BMJ editor at the time.”
Still, it’s possible the misprint in such a prominent widely-red journal helped disseminate a flawed message about aspirin in primary prevention.
It was never the researchers’ intention to emphasize that daily aspirin in low-risk patients was a good idea, he says.
In general, here’s how aspirin interferes with your blood’s clotting action.
When you bleed, your blood’s clotting cells, called platelets, accumulate at the site of any wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.
But this clotting can also happen within the vessels that supply your heart and brain with blood.
If your blood vessels are already narrowed from atherosclerosis (the accumulation of fatty deposits in your arteries) aspirin therapy in high-risk patients may reduce the clumping action of platelets — possibly preventing heart attack and stroke along with the accompanying increase in bleeding.
That’s why the Harvard Health Letter suggests:
“Routine aspirin use may save lives for those who have ever had a heart attack or stroke, suffer from angina, or have undergone coronary artery bypass surgery.”
But daily low-dose aspirin is not for everybody.
For women under the age of 65 who are not heart patients or at serious risk of heart disease, caution is advised before taking daily aspirin. Aspirin carries a significant risk of bleeding. And that bleeding may be subtle, not immediately apparent, and slowly cumulative over time. Other medications you take also need to be considered with care, particularly other anti-inflammatory meds.
A study in Scotland last year found that healthy people taking a daily dose of aspirin to prevent heart attacks may be doing themselves more harm than good.
Professor Peter Weissberg, medical director of the British Heart Foundation which helped fund the research, explained:
“The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin because the risks of bleeding may outweigh the benefits.”
Read more on this study from the European Society of Cardiology: No Evidence For the Routine Use Of Aspirin In People With Asymptomatic Vascular Events.
NOTE: This aspirin protocol applies to daily preventive low doses only, and not to the important recommendation to immediately chew one full-strength aspirin* (with water) if you believe you are having a heart attack.
* Check with your doctor whether or not taking an aspirin at first sign of heart attack is appropriate for you if you’re already taking certain bloodthinning or anti-platelet medications – or if you’ve ever experienced an allergic reaction to aspirin.
♥ UPDATE from Mayo Clinic, September 6, 2013: “For people who do not have heart disease, the United States Preventive Services Task Force recommends that only men between the ages of 45 and 79 and women ages 55 to 79 take a low-dose aspirin every day to help prevent heart attack and stroke. For people who do have a history of stroke, heart disease or other cardiovascular problems, a daily aspirin can be useful. But it is very important that to discuss with your doctors the risks and benefits of daily aspirin for your particular situation.”
♥ UPDATE from the Journal of the American College of Cardiology, January 2015: “Inappropriate Aspirin Use for the Primary Prevention of Cardiovascular Disease: aspirin should be used in primary prevention cases only if the person has a greater than 10% chance of having a heart attack or stroke in the next 10 years. Aspirin can come with harmful side effects that overshadow any potential benefit they might have. It’s enough of a concern that the Food and Drug Administration recently rejected a request to add primary prevention of heart disease as a benefit of aspirin therapy on the drug’s label.”
♥ UPDATE from the American Heart Association (AHA) and the American College of Cardiology (ACC), March 2019: the AHA and the ACC recommends against the routine use of low-dose (81-mg) aspirin in people older than 70 who do not have existing heart disease and haven’t had a stroke, or in people of any age who have an increased risk for bleeding. Dr. Christopher Cannon, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital, wrote:
“It’s a big shake-up, based on three large studies. Two of the three showed there was no benefit to taking daily aspirin to prevent a first heart attack or stroke, and aspirin was associated with an increased risk for bleeding severe enough to require transfusions or hospitalization. The other study showed that in people with diabetes but no cardiovascular disease, there was benefit, but also risk: a 1% reduction in heart attack risk, and a 1% increase in bleeding risk.”
Q: Has your doctor recommended that you take a daily aspirin?