Checkup on Health
Who should consider taking a daily aspirin?
Aspirin, once mostly used on an occasional basis for fever, aches and pains, is now, for many, taken daily like a vitamin pill. If you’re taking an aspirin daily, is that a wise practice? Alternatively, if you’re not, should you be?
How aspirin works
Aspirin has many effects because it reduces the body’s production of prostaglandins, a hormone-like substance that acts in numerous ways. Reducing prostaglandins diminishes pain and fever and weakens platelets’ ability to stick together and form clots. This characteristic is especially important in lessening the risk of strokes and heart attack, which are caused by clots lodging in coronary arteries or blood vessels in the brain.
Reducing prostaglandins can have harmful effects as well. It can make the stomach lining more vulnerable to ulcer formation and bleeding. And for some people who are prone to asthma, it can trigger an attack.
Who should take aspirin?
Aspirin’s ability to reduce the risk of a second heart attack or stroke has been known for quite a while, and doctors have long advised people who have previously had a heart attack, an ischemic stroke (one caused by a clot) or TIAs (so-called “mini-strokes”) to take a daily aspirin. Patients with unstable angina, who are at very high risk for a heart attack, are also treated with aspirin in the hospital.
There is also enough evidence of aspirin’s benefits in reducing heart attack and stroke risk that doctors are increasingly recommending a daily aspirin for many healthy people. This includes all men over age 50 and all women over age 60, especially if they have even one risk factor for heart disease. Risk factors include a personal or family history of heart disease, having hypertension, being overweight, not exercising, smoking, having high cholesterol or being diabetic.
Who shouldn’t have daily aspirin?
For some individuals, the risks of aspirin therapy itself are greater than the potential benefits. A significant percentage of people develop stomach irritation from aspirin. For many it is mild, but for others who develop ulcers or internal bleeding, the health consequences can be major. Gastric problems can often be avoided by taking the lowest recommended daily dosage or using enteric, or coated aspirin.
People who suffer from severe liver or kidney disease should also avoid aspirin, as should those who consume three or more alcoholic drinks each day. People who are allergic to aspirin, as evidenced by facial swelling or an asthma attack, also must not take aspirin.
High blood pressure, while posing a significant risk for heart attack and stroke, must be brought under control before initiating daily aspirin. High blood pressure greatly increases the risk for hemorrhagic strokes, the type caused by rupture of a small blood vessel and resultant blood leakage into the brain. The anticoagulant properties of aspirin can exacerbate this kind of stroke.
People who have been diagnosed with atrial fibrillation need anticoagulant medication, but aspirin is typically not adequate for their needs. Most are advised to take warfarin (Coumadin), a stronger medication that is generally not combined with aspirin. For minor aches and pains, patients on warfarin should take acetaminophen or another non-aspirin analgesic.
Daily aspirin therapy can be a lifesaver for many, but because of the risks, do not start a program without consulting your physician. Also discuss the best daily dosage for you, which can safely range from 50 mg to 325 mg a day.
Even if you decide not to take a daily aspirin, keep a bottle of chewable baby aspirin in your car and in your medicine cabinet. It’s important to have one on hand in case of a heart attack. Take two 81-mg tablets as soon as any heart attack symptom, such as chest pain or tightness, arises. Then go to a hospital emergency room or call 911 at once.
Aspirin, however, should not be taken at the time of a stroke. Symptoms may include sudden severe headache, dizziness, blurred vision, confusion, weakness or trouble speaking or understanding speech. Before a medical evaluation, it is impossible to determine if a stroke is hemorrhagic, which may worsen with aspirin.