By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Many people take aspirin on a daily basis as a preventive strategy against cardiovascular disease. Is it effective, and if so, what about low-dose aspirin?
The answer is that it depends on what you mean by prevention. If you mean primary prevention, that is, to prevent a first heart attack or stroke down the line, the answer is no.
And the same answer – no – applies to both full-strength aspirin (325 milligrams) and the low-dose version (81-100 milligrams).
There’s no evidence that either is an effective or safe option for primary prevention, or that with low-dose aspirin you can altogether avoid the risk of adverse gastrointestinal effects – such as abdominal pain, heartburn, ulcers, and bleeding − associated with regular full-strength aspirin.
A 2014 study published in the Journal of the American Medical Association reported on the results of a large investigation among more than 14,000 Japanese patients over the age of 60 with some kind of a definite risk factor for heart attack or stroke such as hypertension or diabetes.
These at-risk patients were randomly divided to take either a low-dose aspirin (100 milligrams) once daily or an inert placebo. They were followed for about five years. The results failed to show any significant reduction in cardiovascular deaths, and non-fatal heart attacks or strokes. The patients on the low-dose aspirin experienced almost double the gastrointestinal side effects as those taking the placebo.
The current recommendation from the American Heart Association is that low-dose is the aspirin of choice AFTER an initial cardiovascular event or for someone with diagnosed heart disease. However, many doctors are prescribing regular dose aspirin, and that’s a potential problem because of the known side effects, and especially since studies show low-dose is just as effective and safer for that purpose.
To learn more about the use of aspirin for prevention, take a look at my video and article here.
- Ikeda Y, et al. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors. J American Med Assn. 2014. 312(23):2510-20.
- American Heart Association. Low-dose aspirin as effective as high-dose aspirin at preventing future heart attacks. 2014.
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