My post last week created much confusion and worry.  I received many emails asking “What about me?  Should I keep taking aspirin or not?”

Let me clarify the issue by explaining what we already knew before last week’s study in the British Medical Journal.  We knew that aspirin is valuable in:

  • patients who have had a stroke
  • patients who have had a heart attack
  • patients who have had bypass surgery or angioplasty
  • patients with angina (chest pain or discomfort caused by narrowing of coronary arteries)
  • patients with claudication (calf pain caused by narrowing of leg arteries)

So patients in the above groups should take aspirin unless they have had an adverse reaction from aspirin.  Last week’s study was not about those patients.

Last week’s study was about patients with multiple risk factors for heart attack but who had not had a heart attack or a stroke.  Risk factors for heart attack and stroke are:

  • age (men over 45, women over 55)
  • smoking
  • high blood pressure
  • high cholesterol
  • diabetes
  • a parent or sibling with a heart attack early in life (male relative before age 55, female relative before age 65)

The US Preventive Services Task Force (USPSTF) and the American Heart Association (AHA) currently recommend aspirin to prevent a first heart attack or stroke for patients with multiple risk factors for heart attack and stroke.  Last week’s study disagreed with those recommendations, suggesting that aspirin does not prevent a first heart attack in high-risk patients.

My friend and colleague, Dr. Yaron Elad, emailed me arguing that I should not change my practice based on a single study.  He and I dug through the studies supporting the USPSTF and AHA recommendations and decided that he was right.  There is still a lot of evidence that aspirin helps prevent a first heart attack in patients at high risk of heart attacks.  So I retract my conclusions last week, and I’m grateful for Dr. Elad’s input.

Finally, and most importantly, talk to your doctor before making a decision.

Learn more:

My post from last week: Aspirin Doesn’t Prevent Heart Attacks in Patients with Diabetes

The US Preventive Services Task Force recommendation: Aspirin for the Primary Prevention of Cardiovascular Events

American Heart Association recommendation: Aspirin in Heart Attack and Stroke Prevention