Should I take aspirin to help prevent a heart attack or stroke?

Consumer Reports News: June 27, 2013 01:08 PM

It depends. Before considering aspirin therapy, however, you should talk with your doctor about how the risks and benefits apply to you. Aspirin can help prevent the formation of artery-clogging blood clots that can trigger heart attacks and stroke. Those clots are especially dangerous in people whose arteries are already narrowed due to a buildup of plaque, called atherosclerosis.

But, aspirin also has downsides. It can lead to ulcers, stomach and intestinal bleeding, and in rare cases life-threatening hemorrhagic strokes, caused by bleeding in the brain. It can also trigger severe allergic reactions, and cause ringing in the ears, upset stomach, and heartburn, and some recent evidence has linked it to macular degeneration, which causes vision loss. So it's not for everyone.

Here's a guide to help you decide with your doctor whether aspirin is right for your health situation.

You've already had a heart attack, stroke, or have heart disease.
Research shows that daily aspirin cuts the risk of a repeat heart attack or stroke by at least 20 percent and the chance of dying by 10 percent. That's why several major medical associations recommend that people who have been diagnosed with heart disease or who have already experienced a heart attack, stroke, or near stroke (TIA) take a daily 81-milligram aspirin tablet for as long as they can safely tolerate it. "For people in those groups, the data are very clear that the benefits of aspirin outweigh the risk," says Samia Mora, M.D., a cardiologist at Brigham and Women's Hospital in Boston.

You have moderate-to-high cardiovascular risk.
It is less clear if the benefits of aspirin outweigh the risks for people who fall into this category--those who smoke, are inactive, overweight, have high blood pressure, high cholesterol, diabetes, or a family history of early cardiovascular disease (a father or brother who had a heart attack or stroke before age 55; a sister or mother before age 65.) Studies have found that daily aspirin lowers the chance of a heart attack or stroke for people at moderate-to-high risk, but the benefit might be less than for those diagnosed by a doctor with cardiovascular disease, and the risk of bleeding remains the same.

In general, the more of the above risk factors you have, the more you stand to benefit from aspirin therapy.

Low or very-low cardiovascular risk.
If you have a low or very low risk of having a heart attack or stroke, you may not experience much benefit from a daily aspirin, and you expose yourself to all of the possible side effects. To figure out your risk level, try our free risk calculator at ConsumerReports.org/heartrisk. It estimates your 10-year chance of having a heart attack or stroke based on various risk factors.

Experts don't agree on the exact level of risk that warrants starting aspirin therapy. But a reasonable guide is that if your risk of a first heart attack or stroke is 10 percent or higher, at least discuss with your health care provider whether aspirin makes sense for you. "The available evidence suggests that once your risk is more than 10 percent, the benefits of aspirin tilt in your favor," Mora says, though it still comes down to a case-by-case basis.

If you wind up taking daily aspirin, and need something for pain, you should stick mainly with acetaminophen (Tylenol and generic) or creams such as Zostrix than contain capsaicin. It's not a good idea to combine aspirin with pain relievers such as ibuprofen (Advil and generic) and naproxen (Aleve and generic), because the combination can increase the risk of bleeding and even undermine aspirin's blood-thinning effect. If acetaminophen doesn't work well for you, occasional use of naproxen or ibuprofen is OK, as long as you take the aspirin at least four hours before. That will give it a chance to do its job without competing against the other medications.

Finally, don't stop aspirin therapy suddenly as some evidence suggests that could increase your risk of heart attack or stroke.

Teresa Carr


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