Who Should be Taking Aspirin?
Patients often ask if they should be taking aspirin.
As I outlined in a previous post, if you have heart disease, stroke, CABG, stent, MI--you will be prescribed aspirin. So don't stop taking your aspirin unless recommended by your cardiologist.
The only issue is whether or not asprin is beneficial in people who have risk factors for heart disease. The answer is: no. Aspirin may reduce some event risk, but at the expense if GI bleeding. In the past, Medicare and private insurance has not allowed patients to have a simple, inexpensive calcium score. This test may be an out-of-pocket expense. In Hawaii around $200 dollars (around $70 dollars on the mainland)
The calcium score determines the presence of absence of heart disease.
If you have heart disease, take asprin. Take a statin.
If you do not have heart disease, don't take aspirin. Don't take 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 new 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.
"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: take 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.
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.
© 2020. Gregg M. Yamada, MD FACC. All rights reserved.