Who should, and shouldn't, consider taking a daily aspirin?

Who should take aspirin

By Ezra Amsterdam, M.D.

Aspirin, once used only to reduce fever, aches and pains, is now taken by many like a daily vitamin to promote heart and vascular health. But is this wise? And if you are not currently taking aspirin each day, should you?

How aspirin works

About the author

Cardiologist Ezra Amsterdam specializes in helping patients manage acute ischemic syndromes, chest pain, post-myocardial infarction risk and coronary artery disease.

He is frequently called upon to help establish and update national standards for treating and preventing cardiac disease.

Aspirin reduces certain prostaglandins, hormone-like substances in the body linked with inflammation. They also stop platelets in the blood from sticking together and forming clots, reducing the risk of strokes and heart attacks caused by clots in coronary arteries or blood vessels in the brain.

Aspirin, however, isn’t well tolerated by everyone. Reducing the clumping action of platelets may cause internal bleeding, especially in the gastrointestinal (GI) tract, in some people. In individuals with aspirin allergy, the drug can trigger asthma attacks. As a result, the U.S. Food and Drug Administration does not recommend aspirin for preventing a first heart attack or stroke.

Who should take aspirin?

The greater the risk for a heart attack or stroke, the more likely the benefits of aspirin will outweigh the risks. Risk is highest in those who have had a heart attack, ischemic stroke (caused by a clot) or TIA (so-called “mini” or “warning” stroke), and doctors usually advise daily aspirin for these individuals to help prevent a second event. Aspirin is also standard therapy in patients who have had a stent placed in a coronary artery.

Those who cannot tolerate aspirin’s side effects may be asked to try enteric-coated aspirin instead, add a proton pump inhibitor (PPI) to reduce GI symptoms or substitute clopidogrel (Plavix), which also reduces blood clots.

Some who have not had a stroke or heart attack may benefit from aspirin. Doctors may recommend daily aspirin for men over age 45 with risk factors for heart attack and for women over age 55 with risk factors for stroke. Risk factors include a personal or family history of heart disease or stroke, hypertension, smoking, high cholesterol diabetes, overweight or obesity and physical inactivity.

Those who should avoid aspirin

In addition to those who develop GI bleeding or who have aspirin allergy, there are others who should not take aspirin:

  • People who suffer from liver or kidney disease.
  • Those who consume three or more alcoholic drinks each day.
  • Anyone with uncontrolled high blood pressure, which increases the risk for hemorrhagic strokes caused by blood-vessel rupture, which can be exacerbated by aspirin.
  • People who are on anticoagulant (or blood-thinner) therapy should take acetaminophen or another non-aspirin analgesic to treat aches, pain and fever.
  • Anyone who thinks he/she is having a stroke. It is impossible to tell the difference between an ischemic and hemorrhagic stroke, and the outcomes of hemorrhagic stroke may worsen with aspirin.

Ask your doctor

Daily aspirin therapy can save lives but, because of the risks, do not start a daily regimen without consulting first with your physician.

Also discuss the best daily dosage for you, which can range from 81 mg to 325 mg a day.

Updated winter 2015-2016