- Increasingly, research finds daily aspirin, even low-dose aspirin, is associated with bleeding risks.
- A new study out of New Zealand bolsters these findings.
- Daily aspirin can benefit some people, but experts say it should be recommended by a physician.
If you’re confused about whether you should be taking low-dose aspirin for your heart, well, you’re likely not alone.
For many Americans, even healthy ones, taking a baby aspirin or two per day has just been part of a healthy routine, right alongside taking your vitamins and brushing your teeth.
However, an increasing body of research now shows that taking aspirin daily — even at low doses — comes with serious bleeding risks.
Doctors and healthcare organizations, like the American Heart Association, have also updated their recommendations to acknowledge these risks.
What’s clear is that while aspirin does hold benefits for some — namely those who have previously suffered a heart attack or stroke — most people probably shouldn’t be taking it unless they’ve talked to their doctor.
Only a small, select group is likely to derive benefit that outweighs the risks from daily aspirin use, concludes a new study published today in
Researchers at the University of Auckland, New Zealand, looked at a group of nearly 250,000 individuals between the ages of 30 and 79 without cardiovascular disease or previous heart attack and stroke to see whether the benefits of daily aspirin outweighed its risks over a 5-year period.
They found that this was only the case for 2.5 percent of women and 12.1 percent of men.
While only a small number of men and women are likely to benefit from daily aspirin, the study also helps give a better picture of who those individuals are.
Those who were more likely to benefit from daily aspirin generally tended to be older and had higher blood pressure, a greater baseline risk for cardiovascular disease, and worse cholesterol levels.
Current smokers, individuals with diabetes, and people taking cholesterol-lowering medication were also more likely to benefit.
Dr. Vanessa Selak, MBChB, PhD, public health physician and senior lecturer at the University of Auckland and first author of the study, hopes that her research will encourage more people to speak with their doctors about daily aspirin use to see if it’s right for them.
“Healthy individuals should make the decision to take daily aspirin in consultation with their physician. Our research indicates that identifying which individuals are likely to derive net benefit from aspirin requires a personalized assessment of their expected benefits (cardiovascular events avoided) and harms (serious bleeds caused),” she told Healthline.
The growing acknowledgement that taking aspirin daily can be harmful means that opening a dialogue between patients and their doctors about the drug is paramount.
Millions of Americans still take aspirin daily without their doctor’s knowledge or approval.
Research in July 2019, also in Annals of Internal Medicine, found that in the United States, nearly 7 million people take aspirin every day without their doctor’s recommendation. The trend grows even higher for older individuals.
According to the study, about half of adults 70 and older without heart disease reported taking aspirin daily.
In 2018, a trio of studies published in the New England Journal of Medicine critical of taking aspirin daily served as a watershed moment in changing public dialogue on the subject.
The first study, a randomized, double-blind, placebo-controlled trial, found that over nearly 5 years, there was no observable difference in terms of “disability-free survival” between individuals taking aspirin and individuals taking a placebo.
The second study found a major increased risk of internal bleeding among those taking aspirin compared to placebo.
The third unexpectedly found “higher all-cause mortality… among apparently healthy older adults” in those taking aspirin compared with a placebo.
“While 2018 may have given aspirin lovers a headache after 3 aspirin studies demonstrated no benefit in primary prevention and were associated with an increased risk of bleeding, 2019 has provided some relief by slightly opening the door and acknowledging that there is a group of patients that may benefit from aspirin treatment,” said Dr. Guy L. Mintz, director of cardiovascular health & lipidology, Northwell Health’s Sandra Atlas Bass Heart Hospital, Manhasset, New York.
Mintz wasn’t affiliated with any of the aforementioned studies.
The American Heart Association, which has its own set of guidelines on daily aspirin, says the new study is in line with their own conclusions.
“I think the current article very much supports our recommendations,” said Dr. Amit Khera, a professor of medicine at UT Southwestern and a co-author of the AHA/ACC 2019 Prevention Guidelines.
“There are some individuals that may benefit, but it’s a small, select group. We need to not use aspirin broadly, but selectively,” he added.
Khera noted that the general wisdom in recommending aspirin for individuals without cardiovascular disease or history of heart attack and stroke has changed profoundly in recent years. Previously, aspirin was generally advised for many people while only discouraged in select high-risk groups.
Today that recommendation has flipped on its head, with aspirin only being advised for a small section of the population, and generally discouraged for the majority of healthy individuals.
All of the experts interviewed for this story encourage patients to speak with their doctors about whether or not daily aspirin is right for them.
“There’s some notion that it’s a benign medicine, like a vitamin if you will, but it’s not. It’s a medication,” said Dr. Khera.