Aspirin has long been considered a lifesaving option to lower the risk of heart attack or stroke.
In fact, aspirin has been used for centuries for medical purposes, beginning more than 2,500 years ago when Egyptian physicians used willow bark as a pain reliever. Aspirin is also one of the most studied therapies in cardiovascular disease over the last half century.
However, taking a daily aspirin isn’t an option for everyone. Is it right for you? It depends on a variety of factors including age, general health, history of heart health, and more, which you should discuss with your provider.
In this Q&A, Matthew Tomey, MD, a cardiologist and Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai, discusses who should take aspirin and how it can help patients who have had a heart attack.
Matthew Tomey, MD
Is aspirin helpful for heart health and why?
Aspirin helps to reduce the risk of blood clots. For this reason, aspirin continues to be a useful and helpful tool to protect heart health in appropriate individuals and contexts.
Who should take aspirin for heart health?
The benefits of aspirin must be balanced against potential harms, such as gastrointestinal side effects and bleeding. How these pros and cons compare will vary across individuals and circumstances. Evidence from recent published studies suggests that routine use of aspirin for “primary prevention” of cardiovascular disease may not be beneficial on balance.
Aspirin may still be appropriate for primary prevention in individual’s age 40 to 70 who are assessed to be at higher risk of cardiovascular disease. It is very important to distinguish “primary prevention” from “secondary prevention.” By secondary prevention I mean preventing events in individuals with a history of cardiovascular disease and/or treatments such as angioplasty and bypass surgery. Aspirin remains a key component of medical therapy in this context. If you have been prescribed aspirin by a doctor for secondary prevention, it is always appropriate to discuss risks and benefits of aspirin with your doctor. I would caution against independently stopping aspirin unless a clear plan is in place with your doctor.
Who should not take aspirin for heart health?
In general, aspirin should not be routinely used for primary prevention of cardiovascular disease. Individuals at high risk of bleeding, regardless of age, should not use aspirin for primary prevention.
If you’ve already had a heart attack, how is aspirin helpful in recovery?
Aspirin is a standard part of the medical regimen for individuals who have experienced a heart attack (myocardial infarction). Aspirin helps to reduce risk of a recurrent heart attack. Because of its anti-clotting properties, aspirin can also reduce the risk of other adverse cardiovascular events, including stroke. It is important to realize that in individuals with heart attacks, the disease of the heart arteries responsible for most heart attacks is often also found in other arteries around the body. For individuals who receive treatment with angioplasty and stenting or bypass surgery, aspirin plays an important role in preventing clotting of the freshly treated blood vessel.
How is aspirin helpful in other health areas?
Because of its anti-clotting properties, aspirin can be used not only for prevention and for treatment of heart attack but also for prevention and treatment of blood clots in other blood vessels. Aspirin has anti-inflammatory and analgesic properties, and can be used to treat fever, pain, and inflammatory conditions. Aspirin may also help to reduce the risk of colorectal cancer.
If you are unable to take aspirin, is there another alternative?
Depending on the reason for use of aspirin, there are alternatives available. For primary prevention of heart disease, a better alternative to aspirin for most individuals is instead a focus on what the American Heart Association calls “Life’s Essential 8”: healthy blood pressure, blood sugar, blood cholesterol, sleep, weight, exercise, diet, and avoiding smoking. For individuals who require an anti-clotting therapy for secondary prevention, we have a number of options available for “anti-platelet” therapy as well as “anti-coagulant” therapy. Whether one of these is appropriate for an individual requires personalized consideration and physician guidance.