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The Villages
Monday, June 17, 2024

Should you take aspirin to help prevent a heart attack?

Dr. Gabe Mirkin

Most heart attacks are caused by clots, and aspirin helps to prevent clots, but taking aspirin to prevent clots may cause bleeding so it is not for everyone.
• In 1988, a study reported an impressive 44 percent reduction in heart attacks in North American male physicians, aged 40-84, who took aspirin (N Engl J Med, January 28, 1988;318(4):245-246). As a result, by 2017, many people took aspirin with the belief that they were helping to prevent heart attacks. That’s seven percent of those aged 40-49, 18 percent of ages 50–59, 35 percent of ages 60–69, 45 percent of ages 70–79 and more than 45 percent of those over 80 (Ann Intern Med, 2019 Oct 15; 0171(8): 596–598).
• In 2018, a study found that aspirin may have killed as many people as it helped by causing bleeding into the brain and stomach (N Engl J Med Sept 16, 2018;379(16):1509-1518). As a result, the American College of Cardiology and American Heart Association recommended that low-dose aspirin might not be considered for everyone and should be specifically aimed at the primary prevention of heart attacks for select adults 40-70 years of age.
• At this time, the United States Preventive Services Task Force recommends aspirin for adults aged 40-59 years with a greater than 10 percent risk for heart disease. However, taking aspirin should be considered on an individual basis and most doctors do not recommend the regular use of aspirin for people over 60. Aging is associated with increased risk for heart attacks, but it is also associated with increased risk for bleeding into the brain and stomach.

Who Is Likely to Benefit from Aspirin?
Most doctors agree that patients should take low-dose aspirin if they have evidence of clotting problems such as having had a heart attack, a clotting stroke, known heart or blood vessel disease, or any episode of an irregular heartbeat called atrial fibrillation; also if they have had a stent inserted into an artery or vein, or anything else that causes a high risk for forming clots. Most people who are at increased risk for bleeding should not be taking aspirin regularly.

Most heart attacks are caused by a sudden complete obstruction of all blood flow to a part of the heart muscle. A plaque suddenly breaks off from the inner lining of an artery, followed by bleeding and then a clot starts to form and gets larger until it is so large that it blocks completely all blood flow to a part of the heart muscle, so the heart muscle lacks oxygen and dies.

Should You Take Daily Aspirin?
Nobody should start taking regular daily aspirin without first consulting their doctors because of potential bleeding into the brain or stomach. If you are at low risk for a heart attack, the risk of bleeding may exceed any benefit of taking aspirin. In particular, people over the age of 60 who do not have heart or blood vessel diseases or clotting problems may not benefit from taking aspirin. On the other hand, you may be a candidate for taking aspirin if:
• you are 40 to 59 years old and have a 10 percent increased heart attack risk in the next 10 years,
• have had coronary bypass surgery,
• have had a stent placed in a heart artery,
• have chest pain called angina,
• have any other medical condition in which aspirin is proved to prevent heart attacks or strokes, or have diabetes and at least one other heart-disease risk factor, such as smoking or high blood pressure.

Recommended Doses
The ADAPTABLE trial showed that a baby aspirin is just as effective in preventing heart attacks as an adult aspirin, which contains five times that dose (New Engl J Med, May 15, 2021;384(21):1981-1990). A baby aspirin is just as likely to cause bleeding as an adult aspirin.

Regardless of your decision on aspirin, everyone should follow the lifestyle rules that help to prevent heart attacks:
• Lose weight if overweight.
• Exercise, preferably every day.
• Avoid smoking and second-hand smoke.
• Severely restrict or avoid alcohol.
• Eat a healthful diet with plenty of fruits, vegetables, nuts and other seeds. Limit or avoid sugared drinks, sugar-added foods, red meat, processed meats and fried foods.
• Keep hydroxy vitamin D levels above 30 ng/mL.
• Treat and control high blood pressure, high blood sugar and high cholesterol.
• Restrict exposure to air pollution if possible.

My Recommendations
Aspirin helps to prevent and treat heart attacks, but not everyone should take aspirin because it can cause bleeding into the brain and stomach. Everyone with heart attack risk factors should discuss with their doctors whether or not they are candidates for aspirin therapy.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com

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