Food for Thought : Should You Take an Aspirin a Day?

Aspirin can help protect some people against certain cardiovascular diseases. Learn how aspirin works, and who should, and should not, take aspirin every day.

By Eleanor Roberts, PhD                 Medically Reviewed by Pat F. Bass III, MD, MPH
A daily dose of aspirin can help prevent cardiovascular disease and many people have improved their health with this practice. But as with all medical advice, there are pros and cons.

A Brief History of Aspirin

The active ingredient in aspirin, salicylate, has been derived from sources such as willow tree bark for centuries. In the 1700s, scientists began to investigate the medicinal properties of willow bark and since the mid-1800s, salicylate has been prescribed for pain.

Aspirin’s effect as an anticoagulant — a substance that prevents blood clotting — was first recognized by a general practitioner, Lawrence Craven, MD. In 1948, he began prescribing daily aspirin, and noted that none of the patients using it had had heart attacks.

In 1989, the Physicians’ Health Study — a huge, long-term study involving 22,071 participants — published results showing that aspirin led to a 44 percent reduction in heart attack risk in people age 50 and over. Following this report, aspirin began to be routinely prescribed as a preventative measure against cardiovascular disease. Another large study by the U.S. Preventive Services Task Force showed that aspirin significantly decreased the number of all coronary events by nearly 30 percent over five years.

Aspirin and Cardiovascular Health

Blood vessel plaques develop when cholesterol and triglycerides form fatty deposits on the walls of blood vessels. This provokes an immune response in the body, which causes white blood cells to collect. Ultimately, the plaques harden and blood flow is reduced. This means that there may not be enough oxygen getting to the heart, resulting in the severe chest pain of angina.

If a plaque breaks off it can leave a wound in the blood vessel, around which platelets (disc-shaped cells that form a clot, or a “thrombus”) clump. This can lead to such restricted blood flow that little or no oxygen gets to the heart, resulting in a heart attack. If the clot breaks off and travels to the brain, it can cause a stroke.

Aspirin helps prevent blood clots in two ways: It interferes with platelet aggregation, or the clumping of platelets together, and it reduces inflammation.

Who Should Take Aspirin?

Not everyone should take aspirin, and you should only take after talking with your doctor.

Guidelines from the American Heart Association and the American College of Cardiology (AHA/ACC) recommend low-dose aspirin only for people who have had a cardiovascular event (a heart attack, angina, heart surgery, hypertension, or a stroke) or if a person is in a “high risk” category for developing a cardiovascular disease (especially those who are diabetic). As there are indications that aspirin may increase the risk side effects including a bleeding stroke, it is not recommended as a preventative measure for people who do not have cardiovascular disease unless they are in a “high risk” category.

Studies on the benefits of aspirin use in women have been mixed. Therefore recommendations on whether or not to take it may be different for women. It is up to you and your doctor to decide if the benefits outweigh the risks.

The recommended dose of aspirin for preventative measures is 75 to 162 milligrams (mg) per day. Studies have shown that taking higher doses doesn’t increase the protective benefits. However, people who have an arterial stent (a small tube designed to keep the affected part of a blood vessel open) may take a higher aspirin dosage (up to 325 mg) for up to six months, if recommended by a doctor.

Aspirin During a Heart Attack

If you think you or someone you're with is having a heart attack call 911 immediately. Emergency personnel will advise as to whether aspirin should be taken, or it may be given when you get to the hospital. This immediate use of aspirin has been shown to increase survival rates from heart attacks. For this type of emergency, non-enteric-coated aspirin is recommended as it is more quickly absorbed.

Possible Side Effects of Aspirin

Aspirin can cause a number of side effects. These include:

Increased bleeding. The most common adverse effect of aspirin is a significant increase in bleeding in the stomach, intestines, nasal vessels (nose bleeds), and skin (bruising).
Stomach problems. Aspirin decreases the secretion of mucous in the stomach, leaving it vulnerable to damage from gastric acid. Gastrointestinal side effects occur more often in older men, smokers, those with hypertension, cardiac failure, kidney problems, or stomach complaints, and those on a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or diclofenac, a steroid, clopidogrel, or warfarin. Although some aspirin have “enteric” coatings that slow their absorption, this has not been shown to decrease bleeding problems compared to non-coated aspirin. To counteract the gastrointestinal problems, people on aspirin therapy may be prescribed an acid reducer known as a proton pump inhibitor, although dose adjustment may be needed as it can reduce the absorption of aspirin.
Aspirin allergy. Some people are allergic to aspirin, and therefore cannot take it at all.
Aspirin can be very useful to help reduce or prevent many forms of cardiovascular disease in those who already have such a problem, or are at high risk for developing one. However, they may not have such a protective effect for women, and people who aren’t at risk should not necessarily take aspirin every day.

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