Daily aspirin might prevent heart attack, stroke

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Q: I am 50 years old and in good health, but a friend recently told me I should take a baby aspirin every day to prevent a heart attack or stroke. Do I really need to take a baby aspirin?

A: The answer to this question depends on a number of factors. The United States Preventive Services Task Force's 2016 guidelines recommend:

  • For ages 50 to 59: Take one low-dose aspirin (81 mg) daily if you have a 10 percent or greater 10-year cardiovascular disease (CVD) risk, with low risk of bleeding; at least a 10-year life expectancy; and are willing to take aspirin for longer than 10 years.
  • For ages 60 to 69: Using the same criteria, decide whether or not to take an aspirin based on your individual health.
  • For those younger than 50 or older than 70: There is insufficient evidence to recommend taking aspirin to prevent CVD or colorectal cancer.

These recommendations are for the use of aspirin for the primary prevention (never had a heart attack or stroke) of CVD and colorectal cancer, without known CVD or increased bleeding risk.

Therefore, the real determination as to whether or not you should take a low-dose daily aspirin depends on your risk for developing heart disease.

The American Heart Association calculates that risk based on age, gender, race, total cholesterol number, good cholesterol (HDL) number, systolic blood pressure number, whether you are already being treated for high blood pressure, are a current smoker, and if you have diabetes.

If any of these variables cause the risk to exceed 10 percent, then the benefits of daily low-dose aspirin are likely warranted, as long as your risk of bleeding is low.

The task force's guidelines also mention the benefits of taking low-dose aspirin to prevent colorectal cancer. This indication is less significant and has less evidence.

Before you start taking a daily low-dose aspirin, your doctor should determine your risk of bleeding.

If you have a history of stomach ulcers, are prone to falling, or take NSAIDS (i.e., Advil or Aleve) on a regular basis, your risk of bleeding is higher. In this case, daily aspirin use might be avoided.

Those who already have heart disease or have had a heart attack are automatically candidates for lifelong low-dose aspirin therapy.

A history of stroke and peripheral vascular disease may also be indications for daily aspirin, if they are not currently being treated with other antiplatelet therapies.

If you are truly healthy, you probably do not need to take a low-dose daily aspirin because your 10-year cardiovascular risk is less than 10 percent.

Only your doctor can help determine if your risk is appropriate for daily low-dose aspirin.

Dr. William E. Kyle is an internal medicine physician at Memorial Health University Physicians - Legacy Center in Okatie.

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