Health Matters

Daily Aspirin: Worth the Risks?

Aug. 18, 2014
Taking a daily aspirin is touted as a simple way to stave off a heart attack or stroke. Yet, a recent study found that many doctors don’t recommend it to patients who might benefit. UR Medicine’s Dr. Michael Mendoza, one of the study’s authors, shares some facts about aspirin therapy.
aspirin tablets
For all of the purported benefits of something as common as aspirin, the advice should be simple—but it’s not.
Guidelines published in 2009 say that men ages 45 to 79 and women ages 55 to 79 should consider taking aspirin daily as one measure to prevent heart disease, as long as the risks of taking aspirin don’t outweigh the benefits. 
That’s where it gets tricky. Determining a person’s potential for benefit or risk is not easy. No wonder it’s confusing for many doctors and their patients.
What it Does
Aspirin is a drug that interferes with platelets in blood, which are needed to form clots in our blood vessels at the site of a wound. Clotting can also happen inside blood vessels deep within our body. If a clot forms in a blood vessel that is already narrowed and hardened (a condition called atherosclerosis)—which can happen in the arteries that supply blood to the heart—blood flow to the heart can stop, causing a heart attack. Aspirin can help prevent blood from clotting. As a result, it can play a role in preventing heart attacks. 
While aspirin offers some clear benefits, there is plenty of debate about how much people should take. Scientists believe that the higher the dose, the greater the benefits. 
For people at greatest risk for heart attack, doctors typically recommend one regular-strength aspirin tablet (325 mg) a day. For those at lower risk for heart disease, most doctors suggest a daily dose of baby aspirin (81 mg), believing that this dose offers the best balance between the preventive benefits of aspirin and the risk of bleeding, which is its most common—and most serious—side effect.
People with high blood pressure or diabetes have a higher chance of heart attack or stroke, so aspirin is recommended at lower doses for these individuals, too. 
There is new evidence that aspirin may reduce the risk of some cancers but the jury is still out on whether that’s true and how best to take aspirin in this situation.
Who’s at Risk?
Aspirin as therapy carries higher risks for people with certain other medical concerns. These include people who:
  • Have a history of bleeding. People who have a history of bleeding problems, especially those who’ve had stomach or digestive tract bleeding, should think twice before taking aspirin, even at the lower dose.  
  • Are elderly. Older adults should consider it carefully because aspirin can affect the kidneys. As we age, our kidneys grow less able to filter our blood. So, medicines that are cleared by the kidneys, including aspirin, can accumulate in the body. This buildup can further stress the kidneys, which alone can be harmful, and can also interfere with how the body processes other medications. In addition, since elderly people commonly take more medications, they may be at greater risk for reduced benefits and more side effects from medications that are affected by our kidneys.  
  • Are already taking blood thinners. Those who take warfarin or other blood-thinning medications should ask their doctor about taking aspirin. There is good reason for taking aspirin in this case, but the risks are greater too.
How and When
Most doctors recommend taking aspirin with meals, to soften the effects on the stomach where most ulcers and bleeding-related complications are likely to occur. For people with a history of ulcers or gastritis, enteric-coated forms of aspirin are thought to allow the aspirin to pass through the stomach and ward off the bleeding side effects, though science has not yet backed that claim.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) or naproxen (Aleve), can also increase the risk of bleeding. For people who take an occasional NSAID, taking aspirin at least eight hours before or half an hour after taking the NSAID can reduce the chances of bleeding. In addition, people who take NSAIDs regularly should think twice about aspirin therapy. Some research suggests that the cardiovascular benefits of aspirin are reduced when a person takes both NSAIDs and aspirin daily.
Ask Your Doctor
Your health care provider is best equipped to help assess the risks and potential benefits of aspirin therapy for you. If your doctor doesn’t bring it up first, it’s a good idea to ask if taking aspirin daily is right for you.
If you need help finding a doctor, click here or call (585) 784-8891.
Michael Mendoza, MD, MPH
Michael D. Mendoza, M.D., M.P.H., is Commissioner of Public Health for Monroe County and associate professor in the Departments of Family Medicine, Public Health Sciences, and Nursing at the University of Rochester Medical Center.