Is Daily Aspirin Right For You?

Aspirin has been in peoples medicine cabinet for over 100 years. Before aspirin was discovered, the bark and leaves of the willow tree were used to relieve pain and fever. The active ingredient in the willow tree bark and leaves is salicin. Eventually aspirin was derived from salicin and Bayer began distributing aspirin powder in 1899.

\From this early beginning a lot of research has been done with aspirin and a lot of information has been gathered. Despite a long history, there are still many unanswered questions. There are many people who use aspirin that should not and many who are not using aspirin that should.
Aspirin Uses (in Adults)

Aspirin can be used to treat pain, fever, inflammation, headache, arthritis and lower the risk of heart attack and stroke. There are some indications aspirin may be effective in preventing Alzheimer's disease and some forms of cancer but it is too early to tell.

The rest of this article focuses on daily low dose aspirin to prevent cardiovascular disease.
Aspirin's Major Risk

The problem is when aspirin is taken daily for extended periods of time such as heart health. In this case there is a serious risk for gastointestinal bleeding. Doctors have been trying to balance the risk of bleeding with the benefit of preventing heart problems.

Secondary Prevention
After someone has had a heart attack or stroke, doctors try to prevent a second event form happening. This is known as secondary prevention. It has been generally accepted that after a heart attack the benefits of daily aspirin therapy out weight the potential risks. In fact the ACC/AHA (American College of Cardiology / American Heart Association) guidelines states all patients (who have had a heart attack or stroke) should be placed on low dose aspirin indefinitely unless contraindicated.

Primary Prevention
Primary prevention is the attempt to prevent a first heat attack from occurring. The U.S. Preventive Services Task Force (USPTF) has published new guidelines to help determine who should be taking aspirin for primary prevention. USPTF aspirin guidelines.
In brief the guidelines state:

Aspirin is not recommended for men younger than 45 or women younger than 55 years.

Aspirin is recommended in men age 45 to 79 years to reduce heart attack risks when the benefit outweighs the risk of gastrointestinal bleeding.

Aspirin is recommended in women age 55 to 79 years to prevent ischemic strokes when the benefit outweighs the risk of gastrointestinal bleeding.

In men and women over 80 years there is not enough evidence to asses the benefits against the potential risks for daily aspirin use.

What dose should you take?
It is still not completely clear what is the ideal dose of aspirin to take to prevent heart attacks and strokes but according to an article in the March 17 Annals of Internal Medicine higher doses are not better than lower doses. In fact, lower doses in the 75 to 81mg range are as effective as higher doses but have a lower risk associated with them. This is especially true if Plavix (clopidogrel) is given with aspirin.

Conclusion
There is still more research to be done to evaluate who should and should not take aspirin but these new guidelines bring us a few steps closer. As always, every person is different and you should discuss the risks and benefits of aspirin therapy for your specific situation.