The Ultimate Guide To Aspirin In Cardiovascular Disease Prevention

Aspirin is a unique drug, the prototypical  two-edged sword of pharmaceuticals.  It has the capability of stopping platelets, the sticky elements in our blood, from forming clots that cause strokes and heart attacks when arterial plaques rupture, but it increases the risk of serious bleeding into the brain or from the GI tract. Despite these powerful properties, aspirin is available over the counter and is very cheap, thus anyone can take it in any dosage they want. 

For the last 10  years I’ve been advising my patients who have no evidence of atherosclerotic vascular disease against taking aspirin to prevent heart attack and stroke. Several comprehensive reviews of all the randomized trials of aspirin had concluded by 2011 that

The current totality of evidence provides only modest support for a benefit of aspirin in patients without clinical cardiovascular disease, which is offset by its risk. For every 1,000 subjects treated with aspirin over a 5-year period, aspirin would prevent 2.9 MCE and cause 2.8 major bleeds.

(MCE=major cardiovascular events, e.g. stroke, heart attack, death from cardiovascular disease)

Dr. Oz, on the other hand, came to St. Louis in 2011 to have  lunch with five hundred women and advised them all to take a baby aspirin daily (and fish oil, which is not indicated for primary prevention as I have discussed here). When I saw these women subsequently in my office I had to spend a fair amount of our visit explaining why they didn’t need to take aspirin and fish oil.

I’ve written a lot on aspirin beginning with my 2014 post “who should taken an aspirin daily.

 

Who Should Take an Aspirin daily?

Does Aspirin Have A Role In Stroke Prevention In Atrial Fibrillation Or Is It Time To Start Stopping It?

What John Mandrola Learned About Aspirin in Munich

Revisiting Who Should Take Aspirin

Thoughts On Prolonged Bleeding Whilst Taking Baby Aspirin

Which Kind of Baby Aspirin Should I Take To Prevent Heart Attack? Chewable Versus Enteric Coated Versus Regular

Should I Take Aspirin To Prevent Stroke or Heart Attack?

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Unbiased, evidence-based discussion of the effects of diet, drugs, and procedures on heart disease

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