New aspirin guidelines for heart health
Harvard Health Publications
August 12, 2009
Aspirin was once used mainly to relieve pain and ease fever. Today this hundred-year-old drug is a mainstay for treating heart attacks, and it also helps prevent heart attacks and the most common kind of stroke. But limited evidence on aspirin?s preventive effects has made it difficult for experts to give recommendations about who benefits from daily aspirin and how much to take.
Updated recommendations from the U.S. Preventive Services Task Force fill in two big gaps ? about aspirin for women and about the safest dose to take. The recommendations emphasize weighing the benefits of aspirin therapy against the risks. Making a good decision requires a few numbers, some thought, and input from a trusted physician.
The plusses and minuses of preventive aspirin use
For men, the main benefit of aspirin is preventing a heart attack. For women, it?s preventing the kind of stroke caused by a blood clot (ischemic stroke). It?s the most common kind of stroke. For both, the risks of taking aspirin are gastrointestinal bleeding and hemorrhagic stroke.
It makes the most sense to take aspirin if your chance of having a heart attack or stroke is greater than the odds of aspirin causing a problem. The simplest way to figure your heart disease or stroke risk is to use an online calculator, such as the Framingham or Reynolds risk scores, which give you a percentage. If yours is 13% it means that for every 1,000 people with risk factors like yours, 130 will have a heart attack or stroke over the next 10 years.
Now compare your cardiovascular risk with the chance that taking aspirin will lead to gastrointestinal bleeding or cause a hemorrhagic stroke. The estimates of these complications look like this: before age 59, 0.9% for men and 0.5% for women; from 60 to 69, 2.5% for men and 1.3% for women; and from 70 to 79, 3.7% for men and 1.9% for women.
Several things boost the chances of getting into trouble with aspirin:
Here?s how to put this information together. Say you are a 68-year-old woman with a stroke risk of 18%. By taking aspirin every day, you lower your risk by 25%, to 13.5%. (That translates into 45 fewer heart attacks or strokes for every 1,000 women taking low-dose aspirin.) Your chance of having a problem with aspirin is 1.3%. The benefits definitely outweigh the risks.
What about a 55-year-old man with a 10-year heart attack risk of 2%? Taking aspirin would lower it by 25%, to 1.5%. Since he takes ibuprofen for his arthritis, his chance of having a problem with aspirin is close to 4%. For him, the risk is higher than the benefit.
Trials evaluating the heart benefits of aspirin have tested doses ranging from 500 milligrams (mg) a day to 100 mg every other day. The task force concludes that a dose of 81 mg a day, the amount in a baby aspirin, seems to work just as well as higher doses, with fewer bleeding problems.
Beyond aspirin
Aspirin isn?t a miracle worker. It lowers the chances of having a first heart attack or stroke by 25%, which is great, but it means you can?t rely on aspirin alone to protect you. If you?re really serious, there?s a lot more you can do. The combination of not smoking, maintaining a healthy weight, exercising daily, choosing a healthful diet, and drinking alcohol in moderation lowers the risk of having a heart attack or stroke between 50% and 80%
Harvard Health Publications
August 12, 2009
Aspirin was once used mainly to relieve pain and ease fever. Today this hundred-year-old drug is a mainstay for treating heart attacks, and it also helps prevent heart attacks and the most common kind of stroke. But limited evidence on aspirin?s preventive effects has made it difficult for experts to give recommendations about who benefits from daily aspirin and how much to take.
Updated recommendations from the U.S. Preventive Services Task Force fill in two big gaps ? about aspirin for women and about the safest dose to take. The recommendations emphasize weighing the benefits of aspirin therapy against the risks. Making a good decision requires a few numbers, some thought, and input from a trusted physician.
The plusses and minuses of preventive aspirin use
For men, the main benefit of aspirin is preventing a heart attack. For women, it?s preventing the kind of stroke caused by a blood clot (ischemic stroke). It?s the most common kind of stroke. For both, the risks of taking aspirin are gastrointestinal bleeding and hemorrhagic stroke.
It makes the most sense to take aspirin if your chance of having a heart attack or stroke is greater than the odds of aspirin causing a problem. The simplest way to figure your heart disease or stroke risk is to use an online calculator, such as the Framingham or Reynolds risk scores, which give you a percentage. If yours is 13% it means that for every 1,000 people with risk factors like yours, 130 will have a heart attack or stroke over the next 10 years.
Now compare your cardiovascular risk with the chance that taking aspirin will lead to gastrointestinal bleeding or cause a hemorrhagic stroke. The estimates of these complications look like this: before age 59, 0.9% for men and 0.5% for women; from 60 to 69, 2.5% for men and 1.3% for women; and from 70 to 79, 3.7% for men and 1.9% for women.
Several things boost the chances of getting into trouble with aspirin:
- Regular use of ibuprofen (Advil, generic) or another nonsteroidal anti-inflammatory drug in addition to aspirin increases the risk of gastrointestinal bleeding fourfold.
- Men are twice as likely as women to have gastrointestinal bleeding.
- Having had a gastrointestinal ulcer, gastrointestinal bleeding, or hemorrhagic stroke increases the chances it will recur.
- Uncontrolled high blood pressure or use of an anticoagulant such as warfarin (Coumadin, Jantoven, generic) also increases the risk for a hemorrhagic stroke or serious bleeding.
Here?s how to put this information together. Say you are a 68-year-old woman with a stroke risk of 18%. By taking aspirin every day, you lower your risk by 25%, to 13.5%. (That translates into 45 fewer heart attacks or strokes for every 1,000 women taking low-dose aspirin.) Your chance of having a problem with aspirin is 1.3%. The benefits definitely outweigh the risks.
What about a 55-year-old man with a 10-year heart attack risk of 2%? Taking aspirin would lower it by 25%, to 1.5%. Since he takes ibuprofen for his arthritis, his chance of having a problem with aspirin is close to 4%. For him, the risk is higher than the benefit.
Trials evaluating the heart benefits of aspirin have tested doses ranging from 500 milligrams (mg) a day to 100 mg every other day. The task force concludes that a dose of 81 mg a day, the amount in a baby aspirin, seems to work just as well as higher doses, with fewer bleeding problems.
Beyond aspirin
Aspirin isn?t a miracle worker. It lowers the chances of having a first heart attack or stroke by 25%, which is great, but it means you can?t rely on aspirin alone to protect you. If you?re really serious, there?s a lot more you can do. The combination of not smoking, maintaining a healthy weight, exercising daily, choosing a healthful diet, and drinking alcohol in moderation lowers the risk of having a heart attack or stroke between 50% and 80%
