This week was supposed to be part 2 of Protecting Your Mind as You Age. But in the meantime, the US Preventative Task Force released guidance on Aspirin. Our office has received many calls asking for guidance. Thus, it will be this week’s topic.

Background

First, let me put Aspirin in context. Aspirin decreases your body’s ability to form blood clots by making cells called platelets less sticky. When you have a heart attack, a clot forms in an artery that supplies blood to the heart, thereby blocking the heart’s ability to get blood. The same thing happens in most strokes. So by lowering your tendency to form clots, Aspirin can lower the risk of heart attacks and strokes. 

Aspirin also decreases inflammation. Inflammation is an important part of our immune system’s response to sickness or injury. But prolonged inflammation can cause harm. Aspirin’s anti-inflammatory effect is thought to be the mechanism by which it may lower risk of developing colon cancer according to a number of studies.

But like most meds, Aspirin has downsides. Hindering your ability to form clots increases the risk of bleeding in your brain and digestive tract. As we age, the risk from bleeding increases. For instance, an older person who falls and hits their head might be more prone to bleed in their brain if they’re on Aspirin.

So Should I Take Aspirin?

It depends on your unique health situation, including your medical conditions and the other meds you take. So you should communicate with your doctor if you’re not sure what to do. In the interim, stay on Aspirin if your doctor instructed you to do so. Here are the principles your doctor will use to decide if Aspirin will help you.

Aspirin lowers risk of heart attacks and strokes in people with coronary artery disease and cerebrovascular disease.

If you’ve had a heart attack or been found to have significant narrowing in your coronary (heart) arteries, Aspirin has proven benefit. Likewise, if you’ve had a stroke, Aspirin has evidence of lowering the risk of having another one. So for many people with coronary artery disease and cerebrovascular disease, Aspirin continues to be beneficial. But even here the details matter. For instance, some with people with coronary artery disease or cerebrovascular take other meds that decrease clotting such as Plavix, Eliquis, Warfarin, or Xarelto. Adding Aspirin to these meds might do more harm than good. This kind of scenario is why there is no substitute for communicating with your doctor about your particular situation.

Aspirin doesn’t have strong evidence for preventing heart attacks and strokes in people without coronary artery disease or cerebrovascular disease.

If you don’t have significant narrowing in your coronary arteries or have never had a heart attack, there isn’t strong evidence Aspirin will lower your risk of having heart disease. Likewise, if you’ve never had a stroke or mini-stroke, Aspirin doesn’t have strong evidence for decreasing your risk of having a stroke. In these scenarios, you’re unlikely to benefit from Aspirin, but it will increase your risk of bleeding. The bad outweighs the good.

What the U.S. Preventative Task Force (USPTF) Recommended

USPTF is an organization that reviews evidence and provides guidance on how to prevent health problems.  After reviewing the latest studies on Aspirin, USPTF issued updated recommendations for people without a history of coronary artery disease or cerebrovascular disease. If you have a history of narrowing in your coronary arteries, having a heart attack, or having had a stroke or mini-stroke, these recommendations, don’t apply to you.

In people 60 years and older, do not start Aspirin to prevent cardiovascular disease. 

This is because Aspirin doesn’t have strong evidence to prevent heart disease. It does, however, increase the risk of bleeding–a risk that worsens with age.

In people 40-59 years old, discuss whether or not to start Aspirin with your doctor.

A risk calculator can estimate your risk of developing cardiovascular disease over the next 10 years. It takes into account risk factors such as diabetes, smoking history, cholesterol level, and family history of heart disease. If your estimated risk is over 10%, you and your doctor can discuss if the benefits of taking Aspirin outweigh the increased risk of bleeding.

Bottom Line

If your physician has instructed you to be on Aspirin, stay on it until you’ve communicated with him or her. If you’ve had a heart attack or narrowing in your coronary arteries that required a stent or bypass surgery, you’ll most likely need to stay on Aspirin. The same is true if you’ve had a stroke or mini-stroke. If you don’t have a history of coronary artery disease or cerebrovascular disease and are taking Aspirin, talk with your physician about whether it’s worth continuing to do so. There is no urgency in having this conversation. The risk from taking a low dose Aspirin (such as 81 mg) daily over a short period of time is low.