Should We Be Taking Aspirin Prophylaxis for Heart Disease?
Aspirin is commonly prescribed to individuals with established heart disease to help reduce the risk of additional events such as heart attack or stroke (known as secondary prevention). More recently, significant debate has surrounded taking aspirin prophylactically to prevent a heart attack or stroke for those who have never suffered a prior heart attack or stroke (known as primary prevention).
What is aspirin and how does it work?
Aspirin, also known as acetylsalicylic acid (ASA), has a number of effects, one of which is to help thin the blood. The blood thinning activity of aspirin comes from its ability to block the enzyme COX-1 that is involved in formation of a chemical thromboxane A2 in platelets, small globules or fragments in the blood that clump together to help form clots. By blocking thromboxane A2 platelets have a severely reduced ability to clump together, thereby “thinning the blood.”
Who should be taking aspirin regularly?
Commonly, those individuals with a prior heart attack, stroke or heart procedure such as a stent in the heart, heart bypass surgery, or heart valve replacement are prescribed aspirin to help lower the risk of future stroke and heart attack. More recently, it has been recommended that individuals that have never had a stroke, heart attack or prior heart procedure do not take a daily aspirin to reduce their risk of their first heart attack or stroke unless they are high risk for heart attack and lower risk of bleeding. Some groups who may benefit from aspirin for primary prevention include:
- Individuals between the age of 40-59 years old who have a 10% or higher risk of heart attack in the next 10 years may benefit from daily aspirin according to the U.S. Preventive Services Task Force. Cardiac risk calculators can be used to estimate 10-year risk including the calculator from the American College of Cardiology or the Mesa 10 Year Risk calculator.
- Diabetics that are less than 60 years old with at least one additional risk factor for heart disease including, tobacco use, elevated blood pressure, or significantly elevated cholesterol.
- In a group of individuals with a significantly elevated lipoprotein(a) (also known as Lpl(a)), which is a marker of high risk for heart disease, it is suggested that a daily aspirin may be useful to prevent heart attack.
Individuals who should likely not take aspirin for primary prevention:
- Individuals who have active bleeding, or prior history of bleeding without consulting with your doctor
- Individuals with an aspirin allergy, without consulting with your physician
- Individuals with a clotting disorder that increases the risk of bleeding, without consulting with your physician
- Individuals on other blood thinners, without consulting with your physician
- Individuals less than 40 years old that have a low risk of heart attack and stroke.
- Individuals over the age of 60 according to U.S. Preventive Services Task Force and over the age of 70 according to American Heart Association guidelines, without a prior history of heart attack, stroke or heart procedures.
Are their any natural supplements or remedies that I should be concerned about taking with aspirin?
A number of natural remedies or supplements may thin the blood and increase the risk of bleeding. Consult with a physician when taking supplements, especially those listed below:
- Omega-3 fatty acids (fish oil)
- Turmeric
- Ginko biloba
- Ginger
- Cayenne pepper
- Vitamin E
- Cinnamon
- Dong quai
- Grade seed extract
- Bromelain
- Feverfew
- Aloe
- Evening primrose
The above is meant for informational purposes and does not serve as medical advice. All medical decisions should be made between an individual and their healthcare provider.