Wednesday, January 6, 2016

Health Article: An Aspirin a Day: Yes or No?

I've heard there are new guidelines about taking aspirin for prevention of a heart attack or stroke. As a preventive cardiologist, what's your opinion on this?
— Judy, New Jersey
Many of my cardiology patients ask about the value of taking daily aspirin to prevent heart attack and stroke. Recent research has shed new light on this. Indeed, mounting evidence reported in a number of leading medical journals now suggests that if you’re healthy and not at significant risk for a heart attack, you should not be taking aspirin preventively. That’s because the studies show that aspirin doesn’t reduce the risk of dying from a heart attack or stroke in healthy people. Furthermore, the potential risk of a cerebral hemorrhage, gastrointestinal bleeding, and ulcers outweighs any heart benefits the aspirin might provide.
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However, if you've already had a heart attack or stroke, or if you have been found by your doctor to be at high or moderate risk for heart attack or stroke, the benefits of taking aspirin can trump the risks. That’s because aspirin acts as an anti-inflammatory and an inhibitor of blood clotting. For those at risk, aspirin is one of the drugs in our arsenal (along with statins, ACE inhibitors, and beta blockers) that can help keep a coronary event from occurring in the first place or recurring.
As far as what dosage works best in people for whom aspirin is recommended, I suggest you consult your own doctor. Based on the new research, I no longer recommend aspirin (not even 81 mg low-dose, or baby, aspirin) for any of my healthy patients, because the risk of bleeding is two to four times greater than if you aren’t taking aspirin at all. I do, however, continue to recommend 162 milligrams daily (two low-dose aspirin) to patients who already have coronary heart disease, have already had a heart attack or stroke, or who are at high or moderate risk for one and not at risk for gastrointestinal bleeding. 

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