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Ask the Doctor: Is taking an aspirin every day good for my heart health?

We posed this question to Madeline Mahowald, MD, a University of Florida assistant professor of medicine and a board-certified interventional cardiologist at UF Health Jacksonville.

Dr. Madeline Mahowald

You may have heard advice that a daily low-dose or baby aspirin is a good way to prevent a heart attack or stroke. Yet recent research suggests otherwise. Madeline Mahowald, MD, a University of Florida assistant professor of medicine and a board-certified interventional cardiologist at UF Health Jacksonville, explains why taking a daily aspirin is not recommended for everyone.

Q. Is taking an aspirin every day good for my heart health?

A: Like most things in medicine, it depends a lot on individual patient factors. It seems to benefit some patients, but it can also put you at unnecessary risk. And so, all medication decisions that you make should be discussed with your doctor and should weigh the potential benefits and the risks of the medication for an individualized decision.

Q. What is the risk of taking aspirin?

A. The main risk is increased bleeding. Aspirin can cause dangerous bleeding, meaning bleeding in the stomach, bleeding in the brain, or bleeding that would require a blood transfusion or a procedure to stop. The risk of dangerous bleeding is why we no longer recommend aspirin for everybody. The older you are and the more other medical issues you have, the higher your risk.

Q. What does updated research indicate?

A. Previous research suggested that daily aspirin caused a slight decrease in the risk of stroke in women and a slight decrease in the risk of heart attack for men. While that may be true, the latest research indicates that the number of patients who benefit from aspirin is about equal to the number of patients who have a dangerous bleed because of aspirin. And so, except in very specific cases, we no longer recommend aspirin for everybody as primary prevention.

Q. Who might benefit from a daily dose of aspirin?

A. Patients who may benefit are those at the highest risk of having a heart attack or stroke. So, if you have previously had a heart attack or a stroke or had a heart stent placed, you are generally considered to be at high risk for another event. Many of these patients will be prescribed aspirin or a similar medication to prevent a second event from happening. Yet the decision can be more complicated because it sometimes depends on what other medications you are taking. For example, patients taking blood thinners may not be advised to take a daily aspirin even if they do have heart disease.

Q. What is low-dose aspirin for heart disease? What does it do?

A. Low-dose aspirin in the United States is typically considered 81 mg per day. Outside of the U.S. it can be found in doses around 100 mg a day, and that would also be considered low dose. Aspirin works to prevent the formation of blood clots, one of the most common ways that heart attacks can happen. And so if you are having a heart attack or you are at risk for having a heart attack, aspirin can prevent that from occurring.

Q. Should I take aspirin if I think I’m having a heart attack?

A. Many prior heart patients keep their baby aspirin with them in case they have symptoms they believe might be a heart attack. The dose would be four baby aspirin. Most of the time, however, if you call an ambulance or arrive at the emergency department, and they think there’s a high suspicion you’re having a heart attack, they will often give you aspirin immediately to prevent an existing clot from expanding. Although I do not often advise my patients to take aspirin unless a medical professional recommends that they take it, this is something you should discuss with your doctor.

Q. Other than medications, what can I do to help prevent heart attacks and stroke?

A. I tell my patients that what they eat and what activities they do are the most important ways to impact their heart health. Here are my three general rules that have stood the test of time and are simple to follow:

  1. Eat as many vegetables as possible.
  2. Use olive oil as your primary source of fat, because it tends to have the best support for heart health over other vegetable oils.
  3. Minimize the amount of sugar and processed foods in your diet.

I think if you can do those three things, I would consider that to be a heart-heathy diet without making you count grams of nutrients or try to follow what is often conflicting and constantly changing information.

As far as exercise, much of the benefit for physical activity comes from mild to moderate activity, and so I don’t want my patients to think they have to run marathons or do high-intensity exercise classes. I do recommend 30 minutes of aerobic exercise every day — whether consecutive or broken up into 10-minute bursts — that raises your heart rate, gets you breathing a bit heavier and makes you break a sweat. Simply standing on the job unfortunately is not considered aerobic exercise.

A note from UF Health Jacksonville: The information provided is for educational purposes only. It is specific only to heart and vascular disease and does not relate to other medical conditions that require people to take aspirin. The information is not a substitute for professional medical advice from an examining physician or other appropriate health care provider. Do not begin or stop aspirin therapy without first talking with your health care provider to assess the risks and benefits and determine if it is the best choice for you.

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