Headlines scream: “Low-dose aspirin doesn’t help prevent heart attacks!” That’s what it seems a new U.S. Food and Drug Administration finding suggests, but that’s wrong, and the facts are more complex.
What the FDA is actually stating: Taking a daily aspirin can help some people prevent a first stroke or heart attack, but for many people the risks of intestinal bleeding are greater than the potential cardiovascular benefits. So it is not allowing marketing claims to say otherwise.
And it also acknowledges that this point of view may change: According to Robert Temple, M.D., deputy director for clinical science at the FDA, there are ongoing major trials looking at this issue, and as their findings become available, the FDA will review its position.
Until then, the FDA does say that for folks who have already had a stroke or heart attack, taking daily aspirin (from 80-325 mg a day) to prevent a second episode is beneficial and the protective powers exceed the risks.
So, should you be taking aspirin to prevent heart disease, or not? A recent analysis from the University of North Carolina at Chapel Hill did take a look at the risks and benefits, and determined that aspirin’s one-two punch outweighs its downsides. They concluded low-dose aspirin can cut your risk for a first heart attack by at least 22 percent while lowering risk for strokes caused by blood clots, and for the leg pain of peripheral artery disease. At the same time, it reduces the risk and severity of nine cancers, including those of the bladder, colon, esophagus, kidneys, lungs, pancreas, prostate, breast and stomach by up to 40 percent. In contrast, aspirin increases risk for digestive-system bleeding by about 2.5 percent (maybe less, if you take it the way we do).
We believe it all adds up to good evidence for suggesting two low-dose aspirin a day for most guys over age 35 and most women over age 40. So make an informed decision about aspirin (then use it the right way) with these four steps:
1. Get your doc’s OK
For some people, risk for bleeding and/or ulcers with aspirin is higher than average. A review with your doctor is a must before starting aspirin. Factors that boost your odds include age, a history of a peptic or bleeding ulcer, taking pain-relieving NSAIDs regularly for another condition (joint aches), smoking, a heavy alcohol habit, living with chronic emotional stress and/or having an ulcer right now (treatable with antibiotics in most cases). Your doc may suggest taking an acid-blocking proton pump inhibitor with your aspirin for extra protection.
2. Take your aspirin this way
We think two 81 mg tablets or 162 mg total a day is the best dose to guard against cardio events and cancer. Take them together or at different times of day — it’s up to you. Always take a half-glass of warm water before and after. This helps dissolve the pills faster, decreasing chances for gastrointestinal irritation and bleeding. Taking your aspirin with a meal also may help. Tip: Skip coated aspirin. There’s no evidence that it protects against bleeding, and it won’t dissolve as quickly in warm water.
3. Stay safe
Limit the amount of alcohol you drink. If you need to take another nonsteroidal anti-inflammatory pain reliever (like ibuprofen), do it 24 hours before or after your aspirin. Don’t take other NSAIDs plus aspirin on a regular basis; the combo cancels out aspirin’s anti-cancer effects, kind of like two drivers competing for the same parking space, then both giving up! Take one or the other. Call your doc if you do notice warning signs such as ongoing stomach discomfort, nausea, pain or bowel movements that look black or tarry.
4. Keep it up
Be consistent; stopping a daily aspirin suddenly increases risk for clotting, heart attacks and strokes (not to mention impotence). And aspirin’s cancer protection grows stronger the longer you take it.