Patients often ask if they should be taking aspirin.
As I outlined in a previous post, if you have cardiovascular disease (CVD) i.e. heart disease, stroke, CABG, stent, MI, PAD--you will be prescribed aspirin. So don't stop taking your aspirin unless recommended by your doctor.
The only issue is whether or not asprin is beneficial in people who do not have CVD. In other does aspirin prevent heart attacks? The answer is: not necessarily. Aspirin may reduce event risk, but at the expense if GI bleeding.
In 2019, the American Heart Association updated their guidelines for primary prevention of heart disease. Here is a brief summary from the AHA.
In 2022, the US Preventive Task Force (USPTF) created separate guidelines on the US of aspirin that somewhat copied the AHA guidelines. Click here.
As a result of the above, patients were left confused on whether or not they should be taking aspirin or not.
The answer is simple. Ask your doctor.
For those who do not have established cardiovascular disease (see above) a simple calcium score will be helpful. The calcium score determines the presence of absence of heart disease.
If you have heart disease your cardiologist will prescribe a statin.
Your cardiologist may prescribe aspirin if the calcium score is markedly elevated.
If you do not have cardiovascular disease (CVD) your cardiologist will not prescribe aspirin or a statin.
The use of the calcium score is outlined in the recent 2018 AHA/ACC Cholesterol Management Guidelines.
Here is the data that is the basis of the 2019 AHA recommendations for aspirin.
15 Trial meta-analysis: aspirin in primary prevention:
1. Aspirin does not reduce death if you do not have heart disease
2. Aspirin does reduce non-fatal MI.
3. Aspirin does not reduce fatal MI, angina, need for coronary revascularization
4. Aspirin does lower risk of ischemic stroke, but there is a trend to increase risk of a bleeding stroke.
5. Aspirin use is associated with a Higher risk of GI bleeding.
What the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease Recommends Re: Aspirin...
"Low-dose aspirin might be considered for primary prevention of ASCVD in select higher ASCVD adults aged 40-70 years who are not at increased bleeding risk.
Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults >70 years.
Low-dose aspirin should not be administered for primary prevention among adults at any age who are at increased bleeding risk."
In my pratice, here are the key points
1. If you have heart disease or stroke: your doctor will prescribe aspirin 81mg each day.
Aspirin is effective in seconary prevention.
2. For primary prevention: aspirin has questionable benefit.
The use of aspirin will be individualized for each patient, in my practice.
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Stay Healthy!
Gregg M. Yamada MD FACC
Disclaimer: I hope you find my medical blogs to be pertinent, interesting, and thought provoking. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2022. Gregg M. Yamada, MD FACC. All rights reserved.