An aspirin a day keeps the doctor away?
By: Sasha Klemawesch, MD
Maybe not. For a long time, people have taken a baby aspirin regularly (with and/or without their physician’s input), because it seemed like conventional wisdom was that it would help with heart health, and after all, it was “just a baby dose”. However, a recent landmark study has turned the notion of ASA for primary prevention on its head. Primary prevention means that you are trying to prevent something from every happening in the first place, in this case, a heart attack, stroke, or other serious cardiovascular event. Compare this to secondary prevention which is when someone has a heart attack and then they take steps to prevent getting another one in the future. This study is NOT dealing with adults who already have known coronary or significant vascular disease burden (so if you have already had an MI or TIA, you can stop reading).
What the study found was that taking Aspirin did not provide any additional benefit for primary prevention in non-diabetic adults, even those who may have some risk factors such as high blood pressure. In fact, they found a slightly increased risk for bleeding complications in them which outweighed any perceived benefit of the drug.
This idea really flies in the face of what many doctors and cardiologists in particular thought and practiced for a long time, but it is quickly being accepted into standard practice now.
Another caveat though is that the study addressed those adults who were not already on an aspirin regimen, so there is a large cohort of people out there who are already on an Aspirin whether or not it was recommended, an there is somewhat of a question as to if they should be taken off it or not. So far, many doctors err on the side of not recommending curtailing someone’s long-standing regimen, but the jury is still out on how to address this.
The bottom line? If you are not on ASA, have never had an MI or stroke, and no doctor has ever told you to be on ASA, don’t start it willy-nilly “to help your heart”.
And just an aside on ASA from an Emergency perspective, many people do not realize that ASA is one of the most feared overdoses of EM docs. It is more dangerous a drug than many people realize; in adults it can cause both chronic and acute toxicities which are quite nasty, leading to terrible acidosis and other difficult to manage metabolic anomality’s. In children, Oil of Wintergreen which contains the active ingredient in ASA is one of the few “deadly in a dose” drugs; even a lick (<1 tsp) of the concentrated oil can be fatal in pediatric population, so if you have any balms or ointments in the house be SURE to keep them away from children.