To Aspirin, or not to Aspirin: That is the question
This is one question, that Pharmacists and other health care practitioners, are asked about to help prevent cardiovascular events. In the past, there was little debate. If you had any risk factors for heart disease, you took a low daily dose aspirin to lower your heart disease risk. However, recent evidence from medical studies is making practitioners ponder the daily aspirin recommendation. So, should you take a daily aspirin to lower your risk of heart disease? Let us look at the evidence.
How does low dose Aspirin (acetylsalicylic acid or ASA 81mg) help protect your cardiovascular system? ASA has the ability to thin the blood and help prevent blood clots from forming. If blood clots happen to become trapped in smaller or narrowed arteries, this stops or reduces blood flow to organs. If oxygen rich blood flow to the heart is blocked, this is called a heart attack. If blood flow to blocked in the brain, this is called a stroke. Heart attacks and strokes can have long term health consequences. This is the benefit of low dose ASA therapy.
However, there may be risks involved with taking ASA long term. As we have learned, ASA thins the blood and reduces blood clotting. This reduction in the body’s ability to form blood clots may lead to other bleeding complications. The most worrisome are bleeding that might occur in the stomach (ulcers) or in the brain. This is the risk of low dose ASA therapy.
When health care practitioners make recommendations, we look at evidence from medical journals. In the case of ASA, we looked at the findings from a large ASA study published in the UK medical journal The Lancet. What the evidence noted was that if people had a previous cardiovascular event, heart attack or stroke, they benefited from taking ASA daily. In other words, the side effects of ASA were less than the benefits of preventing future blood clots. In medical studies, this is referred to as secondary prevention. So, if you have had a previous cardiovascular event or are at significant risk of cardiovascular disease, talk to your Doctor or Pharmacist about ASA therapy. With this information, your healthcare practitioner can determine if ASA might be helpful.
However, the interesting finding in this Lancet study was regarding the primary prevention of cardiovascular events. In other words, preventing a heart attack or stroke from happening the first time. The evidence suggested that benefits of ASA therapy were not greater that the risk of side effects. There was no significant reduction in the occurrence of strokes. While there was a slight reduction in cardiovascular events, this was balanced with an almost equal increased risk of stomach or brain bleeds. In otherwise healthy people, daily ASA therapy is not recommended for the primary prevention of cardiovascular events. However, your Doctor might still recommend daily ASA if it is thought to be in your best interest. Medical studies are useful, but personalized clinical judgement is also very important.
To further confuse the issue, there is yet another study that low dose ASA might actually be harmful. In a recent issue of the New England Journal of Medicine, healthy seniors might not benefit from low dose ASA. What the researchers found was that, healthy people over the age of 65, who took daily low dose ASA daily received no overall health benefits. In fact, the risk of bleeding outweighed any health benefits. Again this was in patients who were otherwise healthy, but personalized clinical judgement is very important.
Heart attacks and strokes are a leading cause of death and hospitalization in Canada. There are many ways to improve your cardiovascular health. Make healthy food choices, get regular exercise, quit smoking and monitor your blood pressure are but a few of the ways to reduce your risk. Talk with Doctor or Pharmacist whether low dose daily ASA is the right choice for you.
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