Pop a low-dose aspirin daily, prevent blood clots, and save your life. This health mantra has been around for as long as I can remember.
But as I’ve long said, and the U.S. Preventive Services Task Force (USPSTF) recently confirmed, for many people the risks of taking a daily aspirin for primary prevention—prevention of a first heart attack or stroke—far outweigh the benefits.
The Pros and Cons of Aspirin
The rationale for low-dose aspirin is that it helps to thin the blood and prevent clots that can lead to heart attacks and strokes. It does that by blocking the formation of thromboxane A2, which constricts your blood vessels and allows platelets to clump together and form clots at the site of wounds.
The thinking is that if you reduce the amount of thromboxane produced, you reduce the odds of a blood clot forming and, subsequently, a heart attack or stroke.
The downside is that aspirin can also cause internal bleeding in the stomach, intestinal tract, and brain. This includes serious bleeds, such as those that cause hemorrhagic strokes and death—and the risk increases with age.
The Research on Aspirin for Primary Prevention
The USPSTF is an independent group of experts that reviews scientific evidence and provides guidance on preventive healthcare services. In October 2021, they issued updated recommendations on the use of aspirin for primary prevention of cardiovascular disease:
- People aged 60 and older with no history of cardiovascular disease should not start taking daily aspirin, due to bleeding risks.
- Those ages 40–59 who are at higher risk for cardiovascular disease should decide with their doctor whether they should start taking low-dose aspirin.
This echoes the results of a meta-analysis published in the Journal of the American Medical Association, JAMA, which found that individuals with no history of heart disease who took a daily aspirin reduced their risk of having a cardiovascular event by 11%. But their chance of having a major bleeding event shot up by 43%!
The American College of Cardiology and the American Heart Association guidelines also no longer recommend routine use of low-dose aspirin for primary prevention. They do, however, suggest it might be considered in select high-risk individuals aged 40–70 who are at low risk of bleeding.
Should You Take a Daily Aspirin for Your Heart?
I don't recommend daily aspirin for primary prevention for the reasons cited in the most recent research—that the risk of internal bleeding often far outweighs the benefits. Plus, while aspirin can prevent clots from forming, it doesn't change atherosclerotic plaque, which is the underlying cause of heart disease.
But taking a daily aspirin for secondary prevention—if you’ve already had a heart attack or have a history of cardiovascular disease—is just plain good medicine. I regularly advocate aspirin for those who have known heart disease, such as a history of angina, heart attack, angioplasty/stent procedures, or coronary artery bypass surgery. In these cases, I recommend taking one 81 mg of low-dose aspirin daily.
Bottom line, you should take low-dose aspirin only if it is prescribed by your physician who is familiar with your medical history. A daily baby aspirin for patients with known moderate to severe coronary artery disease is still useful, if it can be tolerated without any GI upset. Working closely with your physician is critical.
How Do You Know If Your Aspirin Therapy Is Working?
Let’s say you have had a heart attack and you’re taking daily low-dose aspirin for secondary prevention to protect against a repeat heart attack. How do you know if it’s working?
You may be surprised to learn that about 25% of patients with cardiovascular disease who take aspirin get little benefit. They don’t respond to their initial low dose, causing their doctors to increase the dose—and hence their risk of internal bleeding. In clinical terms, this means they’re “aspirin resistant.”
If you think this might be the case for you, consider taking a simple urine test administered by AspirinWorks that measures your level of 11-dehydrothromboxane B2, an end product of thromboxane metabolism.
If your test results show a low level of thromboxane metabolites in your system, it means your prescribed aspirin therapy is working. If your results are higher up the scale, you would likely benefit from increasing your dosage. However, if you’re already taking the maximum dosage of aspirin, you’re probably aspirin resistant.
What to Do If You’re Aspirin Resistant
If you’re aspirin resistant, talk to your doctor about whether you should stop your daily aspirin regimen so as not to risk bleeding and gastrointestinal side effects. Though that may sound frightening, you need to keep in perspective that if you’re aspirin resistant, that daily pill wasn’t doing you any good anyway.
It’s also important to remember that the best way to prevent a heart attack is by keeping plaque from forming and building up in the first place. That means back to basics: a healthy lifestyle, weight management, blood pressure-lowering, stress reduction, and nutritional support with antioxidants and anti-inflammatories.
I also recommend natural products that, like aspirin, have been shown to have a slight blood-thinning effect and reduce the risk of blood clots, safely and naturally.
The Natural Approach
Start with a good diet. Avoid trans- and saturated fats, which thicken the blood and encourage platelets to clump together, increasing the likelihood of clot formation. Specific foods with antiplatelet activity are olive oil, salmon and other fatty fish, tea, garlic, ginger, and polyphenol-rich fruits and vegetables like onions, tomatoes, berries, pomegranates, and cocoa (dark chocolate).
A number of nutritional supplements also have a demonstrated ability to inhibit platelet aggregation, improve blood flow, discourage clot formation—and enhance cardiovascular health. They include omega-3 fatty acids, curcumin, grape seed and pine bark extract, quercetin, nattokinase, and natural vitamin E with mixed tocopherols.
This natural approach is your best bet for primary prevention. If you have been diagnosed with cardiovascular disease, talk to your doctor before making changes to your regimen, especially if you are taking low-dose aspirin.