Aspirin: Sorting out the Facts for Cardiovascular Protection

| Posted On Dec 05, 2018 | By:

Although traditionally used as a pain and fever reliever, aspirin has also been used for decades to reduce the risk of heart attack and stroke. However, if you have seen or heard any of the recent news headlines, you may be questioning whether or not you should be taking a daily aspirin for heart protection.

A trio of recently published clinical studies (ARRIVE, ASCEND, and ASPREE) calls into question the benefits of aspirin use for cardiovascular protection and highlights the possible risks associated with its use. But before jumping to any conclusions, it is important to know the facts and understand how this information may or may not apply to you.

For patients with known cardiovascular disease (such as previous heart attack or stroke):

None of the recent clinical studies apply to people who are taking aspirin for “secondary prevention.” Secondary prevention refers to people who already have cardiovascular disease, including a prior heart attack or certain types of stroke, previous coronary stents or cardiac bypass surgery, or symptomatic angina or peripheral artery disease. In people with any of these conditions, aspirin has a clear benefit in reducing the risk of having a second cardiovascular event. While there is a small risk that aspirin can cause bleeding in the brain or stomach, the benefits of aspirin for secondary prevention almost always outweigh the risks.

For patients without known cardiovascular disease:

The benefit of aspirin use in people without known cardiovascular disease, also referred to as “primary prevention,” is not as clear as for those who already have cardiovascular disease.

The ARRIVE trial looked at the use of 100 mg of aspirin daily in men 55 years of age and older and women 60 years of age and older without known cardiovascular disease or diabetes, but with several cardiovascular risk factors including high cholesterol, cigarette smoking, or high blood pressure. Overall, after about 5 years, aspirin use did not reduce the rates of death, heart attacks, or strokes, but it did increase the risk of gastrointestinal bleeding.

The ASCEND trial similarly evaluated the use of 100 mg of aspirin daily in adults, but this time in those with diabetes only (diabetes is a risk factor for future cardiovascular disease). After more than 7 years, aspirin use did lower the risk of major cardiovascular events, but this benefit was closely balanced with an increase for major bleeding.

Lastly, the ASPREE trial looked at starting 100 mg of aspirin daily in generally healthy adults 70 years of age or older without cardiovascular disease. After just under 5 years, aspirin use did not reduce rates of death or cardiovascular events but it did increase major bleeding. An unexpected finding was an increase in cancer-related deaths associated with aspirin use. Aspirin has been historically thought to actually lower certain cancer risks, so the finding in this trial needs to be viewed carefully given that the study may not have been conducted for a long enough period of time to detect its true effects on cancer risk. In any case, the results of this study suggest that beginning aspirin use in people who are generally healthy and 70 years of age or older does not provide an overall benefit and may cause harm.

Bottom line:

If you already have cardiovascular disease and have previously been instructed to take a daily aspirin by your healthcare provider, it is important to continue taking aspirin as advised. Stopping your aspirin, in this case, may put you at higher risk of having a heart attack or stroke. If you have concerns or are not sure if it is right for you to be taking aspirin, check with your healthcare provider before stopping it on your own.

If you do not have cardiovascular disease and have not been told by your healthcare provider to take a daily aspirin, it is important that you do not start taking it on your own. Starting aspirin before a first heart attack or stroke is a complex decision and requires a healthcare provider to help you weigh the risks versus benefits. If you have already been taking aspirin to prevent a first heart attack or stroke based on previous recommendations from your clinician and are no longer sure if you should be taking it after reading the information above, check in with your primary healthcare provider before you stop your aspirin. Some people may be able to safely discontinue aspirin while some may have a high enough cardiovascular risk to warrant continued aspirin therapy.

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About Sandra Elman, PharmD

Sandra Elman, PharmD is a Clinical Pharmacist who currently practices at our Harvard Vanguard Wellesley location. She also serves as the clinical pharmacy liaison to the Cardiology Department at Atrius Health. She joined Atrius Health in 2015 after completing her residency in pharmacy practice at MCPHS University and Atrius Health. Prior to residency, she graduated with a Doctorate of Pharmacy from Northeastern University in Boston, Massachusetts.

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