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Should I take aspirin?

Grumpy Cat Takes Two Aspirin And Keeps Away From Children. Just ...

More Aspirin Data, Less Data for Aspirin

There have been a few articles that came out in the New England Journal in the last month or two on aspirin and while I've talked about this a little before, it warrants a review.

Back when there wasn't much of anything to help prevent heart attacks and strokes, aspirin was great.  For people who are having a heart attack, it's great for treating it.  And for people who have had a heart attack or a stroke or anything where their arteries are suddenly blocked, aspirin is still very good to prevent a recurrence.

One issue with the evidence FOR aspirin is that most of the data came before the age of statins, which reduce the amount of cholesterol in the arteries and also help stabilize the cholesterol plaques that are already there and keep them from breaking off and causing artery blockages in the heart or brain (the main cause of most artery blockages).  So it had been tough to sort out how much EXTRA benefit people on statins got from also taking an aspirin.

BUT everyone is always looking for the best way to prevent their first one of these (called primary prevention) and for a long time I think people were just being told if you're over 40, take an aspirin.  In recent years, that recommendation had been dialed back to just people over 50 who are at higher risk for heart attacks and strokes.

One new study looked at people with diabetes taking aspirin, as diabetes is considered to be as much of a risk for having a heart attack as having already had a heart attack before.  This study did not find any benefit though and actually saw harms related to bleeding episodes as aspirin is a blood thinner.

The other study looked at people over 70 (or over 65 if they were African American or Hispanic) taking a daily preventative aspirin as there wasn't good data on this group and also found no real evidence of benefit and the same harms of causing bleeding episodes.

I think the leaning now is to not have people on aspirin for primary prevention.  It may still be useful for people with uncontrolled blood pressure and cholesterol who smoke, but really at that point there's probably better return on your investment for focusing on the things working against your heart health than there is taking a medication thinking it fixes the problems.

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