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Who should take aspirin for heart health?

March 19, 2020 | UCI Health
woman taking aspirin with a glass of water

It has long been thought that a low dose of aspirin daily helps to prevent heart attacks and stroke, by preventing blood clots. A recent group of studies has rejected that assumption for the general public, provoking considerable discussion among cardiologists and health experts.

“A batch of new trials found that taking aspirin had only a marginal benefit in preventing heart attack in people without heart disease, and it comes with a very significant risk of bleeding,” says Jin K. Kim, MD, PhD, a UCI Health cardiologist who specializes in women’s heart health and non-invasive cardiac testing.

“The changing recommendations as research has evolved can create some confusion for patients,” she added.

What the research says

Today, daily aspirin isn’t recommended for primary prevention — to prevent a first heart attack or stroke — in most men and women who have a low risk of heart disease. Low-dose aspirin also is not routinely recommended for men and women over age 70 for the primary prevention of cardiovascular disease.

“For a long time, there was a differential effect observed between the use of aspirin in men and women, and the guidelines differed,” Kim says.

“But with further research, the recommendations for men and women for primary prevention have converged.”

Should anyone take it?

Is an aspirin a day good for anyone? Current recommendations call for it in:

  • Men and women ages 40 to 70 who are at high risk of developing cardiovascular disease — 10% or greater — in the next 10 years, barring a history of bleeding problems.
  • Men and women who have had a heart attack or stroke.
  • Men and women who haven’t had a heart attack, but who’ve had a stent placed in a coronary artery, had coronary bypass surgery or suffer from angina, or chest pain.

“This is based on the latest research,” Kim says. “It’s still an evolving story, and it will be interesting to see how the recommendation will change five or 10 years down the line.”

How does aspirin work?

Aspirin is widely used to relieve mild or moderate aches and pains, relieve headaches and reduce fever and swelling.

It also works as a very mild blood thinner because it can interfere with the body’s blood-clotting action, Kim explains.

Patients with atherosclerosis — a buildup of fatty deposits in the arteries — are at risk for a fatty deposit bursting and causing the formation of a clot.

Low-dose aspirin interrupts the formation of clots that can block the flow of blood to the heart or brain, resulting in a heart attack or stroke.

Should you stop taking aspirin?

“Patients on aspirin who read the media coverage and want to know if they should discontinue it should first consult their cardiologist,” says Kim.

“In light of these new studies, I think aspirin therapy for prevention of first heart attack or stroke warrants a reassessment for people who do not have known cardiac disease,” she says. “But the decision to take, continue or discontinue aspirin has to be determined individually because there are so many factors that go into the risk calculation.”

Your physician or cardiologist will work with you to make a risk-benefit assessment, considering such factors as personal and family health history, chronic conditions such as diabetes, high blood pressure, smoking and anemia.

Medications and the use of blood-thinning drugs will also be considered.

Your cardiologist may also want to conduct stress tests or other examinations to identify any conditions that may affect treatment decisions.

“Aspirin therapy is a pretty complex decision for the average person to make,” she says. “I urge people not to attempt to make it on their own.”

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