Does an aspirin a day keep the doctor away?

For decades, doctors have been telling their patients, “take two aspirin and call me in the morning.” Indeed, aspirin and time can fix most problems. But in the modern era, many people take daily aspirin to prevent medical problems. Is that really a good idea? New research suggests the risks often outweigh the benefits.

Who definitely benefits from daily aspirin?

You are likely to benefit from daily aspirin if:

  • you’ve had a heart attack, stroke, or arterial stent AND
  • you don’t have a history of major bleeding AND
  • you’re not allergic to aspirin

Of course, you should talk to your doctor before starting to take it.

What about people without prior heart attacks or stroke?

The just-published ASPREE trial (Aspirin in Reducing Events in the Elderly) recruited 20,000 healthy Australian and American patients to take daily aspirin or placebo for five years. All of the patients were 65 or older. Daily aspirin didn’t lower the risk of heart attacks, strokes, or dementia, though it did increase the risk of major bleeding.

Meanwhile, another experiment recruited 15,000 patients with diabetes and no prior heart disease to daily aspirin or placebo for seven years. Again, the average age was mid-60s. Aspirin reduced the risk of heart events by twelve percent. Unfortunately, it also raised the risk of major bleeding by twenty-nine percent. The bottom line is that people with diabetes may benefit from daily aspirin use, but they should speak to their doctors about the bleeding risks.

Of course, if you’re already taking daily aspirin, please speak to your doctor before stopping it.

What about younger people?

Since the above studies focused on older adults, the jury is still out on those aged 60 years old or younger. If your risk of heart events in the next ten years is more than ten percent, you may benefit from daily aspirin. Use this calculator to determine your risk.

Marc Eisenberg, M.D., F.A.C.C.

Marc Sabin Eisenberg, M.D., F.A.C.C., is an associate professor of medicine at Columbia University Medical Center and an attending cardiologist at NewYork-Presbyterian Hospital.

Christopher Kelly, M.D., M.S.

Christopher Rehbeck Kelly, M.D., M.S., is a cardiologist at North Carolina Heart and Vascular and UNC Rex Hospital in Raleigh, North Carolina.