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Should You Take a Daily Aspirin?

More than 50 million North Americans take a baby aspirin daily or every other day because research shows that aspirin can help to prevent heart attacks and colon cancer. Heart attacks and strokes cause 30 percent of deaths in the United States and colon cancer affects more than 140,000 Americans and kills more than 50,000 each year. However, daily aspirin increases risk for bleeding in your gut that can cause stomach ulcers or into your brain that can kill you. These risks are so dire that I believe that the only people who should take daily aspirin are those who are at significant risk for suffering a heart attack.

The United States Preventive Services Task Force (USPSTF) reviewed the world's scientific literature and found that aspirin helps to prevent first-time-heart attacks, ischemic stroke and possibly colon cancer. However, they also found that even very–low–dose aspirin (one baby aspirin/day or every other day) increases risk for gastrointestinal bleeding by 58 percent and hemorrhagic stroke by 27 percent, and that these risks increase with increasing age (Ann Intern Med, June 21, 2016;164(12):826-35). Therefore, the USPSTF recommends that men and women aged 50-69 years who have a 10 percent or higher 10-year risk of heart attacks take a baby aspirin daily to help prevent heart attacks. The American Heart Association recommends that you take daily aspirin only if your chances of developing a heart attack in the next 10 years is greater than five percent. They do not recommend that most people over 70 take aspirin regularly because of their increased risk for bleeding.

Many people believe that taking buffered or enteric-coated aspirin will protect them from stomach bleeding, but these products do nothing to reduce risk of bleeding into the brain and they still can cause gastrointestinal bleeding.

How Can You Tell if You are at High Risk for a Heart Attack?
You are considered to be at high risk for a heart attack if you:
• have had a previous heart attack
• have evidence of heart disease such as chest pain with exercise
• have had any surgical procedure to relieve blocked arteries leading to your heart
• have a high calcium score (CT X-ray scan that measures calcium plaques in arteries)
• are a diabetic with a high calcium score
• have three or more of the following risk factors: triglycerides >150, LDL cholesterol >100, sonogram evidence of a fatty liver, consistent bedtime blood pressure >120/90, fasting blood sugar >100, or blood sugar two hours after meals >120.
Other risk factors include being overweight, storing excess fat in your belly (more than three inches when pinched near your navel), smoking or taking more than two alcoholic drinks a day.

How Aspirin Helps to Prevent Heart Attacks
Aspirin helps to prevent platelets in your bloodstream from forming clots. Heart attacks are not caused just by progressive narrowing of an artery. Plaques usually form on the inner linings of arteries over many years. A heart attack occurs after a plaque breaks off from the inner lining of the artery. Then that area bleeds and a clot forms to try to stop the bleeding. The clot increases in size until it completely blocks blood flow through that artery leading to the heart muscle. The part of the heart muscle that is unable to get its usual supply of blood suffers from lack of oxygen, which usually causes pain and often eventually death to the part of the heart muscle.

Risk Factors for Harm from Aspirin
You are at increased risk for being harmed by taking aspirin if you:
• have an aspirin allergy or intolerance
• are at increased risk for bleeding for any reason
• drink alcohol regularly. The combination of alcohol and aspirin puts you at higher risk for intestinal and stomach bleeding.
• are at risk for falls or are often in situations where you may be pushed or shoved
• are planning to have surgical or dental procedures. Your doctor is likely to tell you to stop taking aspirin a week before a surgical procedure.

Taking Aspirin if You Think You are Having a Heart Attack?
There is data to show that taking an aspirin at the start of a heart attack can decrease clotting, and that chewing an adult aspirin gives you a more immediate inhibition of clotting than swallowing the pill whole. Chewing an adult aspirin tablet for 30 seconds before swallowing it on an empty stomach caused a 50 percent reduction in platelet activity in five minutes, compared to 12 minutes when the aspirin was swallowed whole (The American J of Cardiology, August 15, 1999;84(4):404–409).

However, eating an aspirin should never take the place of getting emergency help as fast as possible. If you develop sudden chest pain that makes you think that you are suffering a heart attack, call 911. You only have approximately an hour and a half for doctors to open a blocked artery leading to the heart. After that, the part of the oxygen-starved heart muscle dies, and you can develop an irregular heartbeat that can kill you. Aspirin can help to prevent the clot from growing, but it also has its own side effects. Never take aspirin if you think you are having a stroke. Many strokes are caused by bleeding and aspirin increases bleeding.

My Recommendations
• Statins and aspirin have been shown to help to prevent heart attacks, but they are not without side effects.
• Heart attacks are more strongly prevented by a healthful lifestyle than by any drugs.
• Follow your doctor's recommendations, but whether or not you take aspirin, statins or any other drugs, make the lifestyle changes that are known to prevent heart attacks at any age. See Plaques in Arteries are Reversible

December 4th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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