Wednesday’s Ask Dr. Walt — Who Should Take an Aspirin a Day?

Dear Dr. Walt,

I see all sorts of different statements about aspirin. Some say take it to prevent heart attacks, strokes, and colon cancer. Others say, nope, only if you’ve had a heart attack or cancer. Others say it can cause death or severe stomach bleeding. My doctors tells me it’s up to me. I don’t know what to do. Help!

—Puzzled in Pennsylvania

Dear Muddled,

We doctors have been given new recommendations from the U.S. Preventive Services Task Force (USPSTF), which are making things a bit clearer. However, the answer for any particular person is still fairly complex. For example, one national group of doctors of pharmacology (pharmacologists) are telling us medical professionals:

  • Using aspirin for primary prevention of cardiovascular disease (stroke or heart attack) is not recommended for all persons (even 50 or older) because the potential benefits do not usually exceed the potential risk of severe bleeding into the gastrointestinal tract or the brain. (In fact, FDA denied Bayer’s request to approve aspirin for primary prevention in 2014.)
  • However, we do know that low-dose daily aspirin is beneficial for secondary prevention of heart attack and strokes because the benefits outweigh bleeding risks irrespective of your age.

Here’s my best attempt to make this complex information a bit easier to understand:

  • If you are under age 50 or age 70 or older, your potential benefits will likely not exceed your risks.
  • If you are age 50 to 69 AND your 10-year cardiovascular risk is less than 10% (you can calculate your individual risk at cvriskcalculator.com), your potential benefits will likely not exceed your risks.
  • However, if you are age 50 to 59 AND your 10-year cardiovascular risk is 10% or greater, consider 81 mg of aspirin, but only if you are not at a high risk for bleeding (for example, you’ve had a previous gastrointestinal bleed, or you are taking a blood thinner, or you have uncontrolled high blood pressure).
  • And, for people age 60 to 69 with a 10% or greater cardiovascular risk and low risk for bleeding, the benefit is even smaller and the risks are greater.

Here’s how I explain this to my patients who wonder whether aspirin is right for them for primary prevention of heart attack, stroke, or colon cancer: For 1000 55-year old men who have a 10-year cardiovascular risk that is greater than 10%, a low-dose (81 mg) daily aspirin over the entire lifetime prevents 36 heart attacks and strokes, while also preventing 12 cases of colorectal cancer. However, the risk includes 26 serious gastrointestinal bleeds and 3 strokes from bleeding. In other words, out of 1000 men, it potentially will help 48 patients and potentially harm 26.

I recommend that patients have a talk with their personal physician about this matter. After all, it’s your doctor who knows you best. And, if your doctor isn’t willing or able to assist you in this decision, consider seeing another physician for a recommendation.


This Q&A was originally published in the May 2015 edition of Today’s Christian Living.

© Copyright WLL, INC. 2016. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.

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