The Pill You Should Consider Taking Every Day: A Cardiologist Explains

How many times have you heard "take two aspirin and call me in the morning”? It may be an old joke, but this potent pill, derived from the bark of willow trees, was first recognized over 2,000 years ago by Hippocrates. About 250 years ago it was isolated from willow bark, and was first synthesized in a chemistry lab 120 years ago.

Today, it's commonly used to treat headaches, pain and fever. And a daily aspirin is usually routine in patients who have suffered a heart attack, stroke or had a heart bypass surgery or stent procedure.

But what about the rest of us? While it may lack the sexiness of fermented foods, a probiotic, or bone broth in terms of media attention, should we consider adding a daily aspirin to our health regimen?

This issue is particularly timely, as the United States Preventive Services Task Force recently published a draft recommendation for the use of aspirin to prevent heart disease and cancer. For the first time, they acknowledge a body of medical literature suggesting a daily aspirin might reduce colorectal cancer, as well as heart disease.

These guidelines are important, given that more than half of all deaths in the U.S. are due to heart disease, stroke or cancer. The USPSTF recommendations for low-dose daily aspirin (81 mg) are:

1. In adults younger than age 50, there is insufficient data to assess the benefit versus harm (most commonly, GI bleeding and ulcers).

2. In adults ages 50 to 59 years, aspirin is recommended to reduce the risk of heart disease and cancer in those who:

  • Have a calculated risk of heart disease of 10% or greater over the next 10 years (using a risk calculator)
  • Are not at increased risk of bleeding
  • Have a life expectancy of at least 10 years (I hope!) and
  • Are willing to take low-dose aspirin for at least 10 years

3. In adults ages 60 to 69 years, who have a calculated heart risk over the next 10 years greater than 10%, the decision to use a daily low-dose aspirin is an individual one with the same comments as in number two above.

4. In adults age 70 and above there is insufficient data to assess the benefit versus the harm of a preventive daily aspirin.

It's important to note that other groups have also made prior recommendations. For example, The American Heart Association and the American Stroke Association recommend low-dose aspirin if the risk calculator is 6% to 10% over the next 10 years. The American Diabetes Association recommends low-dose aspirin in Type 1 and Type 2 diabetics with a 10% or higher risk of heart disease in men over 50 and women over 60. No organization has ever previously recommended low-dose aspirin for cancer prevention.

The Bottom Line

Do I take aspirin? I am a 56 year old with a calculated 10-year risk of a heart event at less than 10% and a coronary artery calcium score of zero. I have a regular screening colonoscopy that has been normal and eat an unprocessed and plant-based diet that is associated with a lower risk of colorectal cancer. Therefore, I do not take a daily aspirin.

But should you? Carefully review the guidelines above and use the calculator. For younger readers of mindbodygreen, aspirin is not recommended, because of lack of data for this age group. For those over 50, it may be wise to add it into your program if you fit the guidelines.

And when should you take an emergency aspirin? If you develop sudden chest tightness, sweating and shortness of breath that you fear could be a heart attack, you should call 911 as soon as possible and then take a full-dose 325 mg aspirin (4 low-dose aspirins). Data from studies 30 years ago suggest an improvement in survival when aspirin therapy is given early in a heart attack.

There is also some suggestion — although less data — that taking an aspirin during a long airplane flight or prolonged sitting might reduce the risk of blood clots in veins.

Please talk to a trusted health care provider before making any decisions about your health plan.

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