The Truth About Aspirin And Your Heart

The calls poured in for Dr. Guy L. Mintz. Patients were confused, worried, and demanding he provide an explanation. What was the cause of their concern? This headline, and the many others like it: “Taking aspirin to prevent heart attack may cause more harm than good.”

The news media was reacting to a new draft recommendation from the U.S. Preventive Services Task Force—the independent and volunteer panel of national experts in disease prevention and evidence-based medicine—questioning the effectiveness of aspirin as a weapon against cardiovascular disease. A quick read of the recommendation might lead you to think you should toss that bottle of baby aspirin into the trash and hope for the best.

“I can’t tell you how many calls we received,” says Mintz, an expert in cardiovascular health and lipidology with Northwell Health. “As soon as the news came out, people were saying, ‘You have me on aspirin and I shouldn’t be on aspirin.’ Even patients who’d had a heart attack and bypass were calling. But the sensational headlines got it wrong.”

Before we delve into those misconceptions, though, we need to understand how a heart attack occurs, and why aspirin became a weapon against them in the first place. When we smoke, or have high cholesterol, or high blood pressure, we can develop cholesterol-rich buildup, or plaque, along our blood vessels. Those vessels can rupture. Platelets rush to the rescue, attempting to stop the bleeding as they might with a cut to the skin, and create a clot that blocks blood flow. Without blood, the heart muscle can begin to die, which leads to a heart attack.

Aspirin has anti-clotting powers, and proved its mettle in a 1988 study that determined 325 milligrams, taken every other day, could decrease cardiovascular mortality.

“But in the 1980s there wasn’t much available to prevent heart attacks; we’d say ‘an aspirin and a prayer,’” Mintz says. “Now we have been able to reduce other risk factors, like high blood pressure, high cholesterol, smoking, diabetes. The benefit of aspirin has become smaller.”

Still, cardiovascular disease remains the leading cause of mortality in the United States, accounting for about one in three deaths. Every year, about 605,000 Americans have a first heart attack and about 610,000 experience a first stroke, according to the American Heart Association.

So the stakes are high, Mintz says, and it’s important to clear up the confusion about aspirin and whether or not you should take it.

First, he says, we need to look at what the task force’s report really says. “The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of cardiovascular events in adults ages 40 to 59 years who have a 10% or greater 10-year cardiovascular disease risk has a small net benefit,” the recommendation reads. “The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults age 60 years or older has no net benefit.”

The concern with this second group is that aspirin could exacerbate the age-related risk of internal bleeding events, ulcers, and the like, Mintz says.

“When patients see me, we assess the overall risk,” he says. “The USPSTF recognizes the clinical decision involves more consideration than the evidence alone. Every patient’s history has to be evaluated.”

And once the patient is evaluated, Mintz might recommend aspirin.

“You can’t say aspirin doesn’t work or causes harm, flat out,” he says. “It is effective as an added tool for some patients. For other patients, who have a risk of bleeding, the risk outweighs the benefit. You should always discuss this with your doctor, and you shouldn’t stop taking aspirin spontaneously after watching a five-second news clip.”

Some of the confusion among Mintz’s patients came from their understanding of primary prevention versus secondary prevention. The latter refers to preventing heart attack in patients who already have cardiovascular disease.

“Some of the patients had a heart attack, or a stent, or a stroke, or a bypass, and they must continue on aspirin therapy,” Mintz cautions. “This new guideline is only for those without heart disease but who are at risk.”

Ultimately, we are in an era of precision medicine, and we should always doubt headlines that generalize and sensationalize, he says.

“You can’t paint everyone with a broad brush,” Mintz says. “You have to assess each patient’s individual risk and create a personalized patient approach.”

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