Who Should Be Taking Aspirin?

A recent report by the US Preventive Services Task Force (USPSTF) has recommended that aspirin not be used to prevent first heart attacks and strokes. This has caused confusion and led to several queries from patients and the public about whether they should stop taking their prescribed aspirin.

What is Aspirin?
Aspirin is a blood thinner that can help prevent heart attacks and strokes by preventing clots from forming in the blood vessels supplying blood to the heart or brain.

It is, however, associated with some serious potential side effects, such as an increased risk of bleeding from the gut (50%) and in the brain (30%). The risk may be under-appreciated as the drug is available over-the-counter, and people may not consider it a “real” drug that needs to be taken under medical supervision.

Aspirin not for elderly with no history of heart disease or stroke
It is important to understand the context of the recommendations that were published. The USPSTF states that for adults 60 years and older, low dose aspirin (100mg in Singapore context) is not to be started for primary prevention of cardiovascular disease (CVD). Primary prevention means that the individual in question does not have any prior history of heart disease or stroke.

Aspirin may be considered for adults between the ages of 40 to 59 years and have a 10% or greater 10-year CVD risk, provided these patients are not at increased risk for bleeding and are willing to take aspirin daily. The 10-year CVD risk may be calculated using a special formula, the ACC/AHA Pooled Cohort Equations, but this is not a perfect calculation for all.

Heart attack and stroke patients should take aspirin
The USPSTF recommendations do not apply to people who have had a heart attack or stroke in the past, or have had previous coronary stenting or coronary bypass operations and are now taking daily aspirin for secondary prevention. For these individuals with established CVD, taking aspirin is vital and effective in preventing another cardiovascular event.

Summary
In short, the recommendations merely state that for those who do not have a history of heart attack and stroke, you should not start to take aspirin just because you have reached 60 years of age.

For younger people between 40 and 59 years with an increased risk of CVD, the decision to initiate aspirin should be made on a case-by-case basis in consultation with your doctor.

But for those patients who have had a prior history of CVD who are already taking aspirin for secondary prevention, you should not stop taking medicine on your own without first discussing the matter with your doctor.

Adopt a healthy lifestyle
An aspirin a day does not necessarily keep the doctor away. Taking aspirin is just one way to help prevent a heart attack or stroke. Other proven strategies for lowering your risks for CVD include adopting healthy lifestyle adjustments, such as quitting smoking, maintaining a healthy diet and doing moderate-intensity exercise on a regular basis.

Article contributed by Prof Tan Huay Cheem, Chairman, Singapore Heart Foundation; Senior Consultant, Department of Cardiology, National University Heart Centre, Singapore.

Read our statement on the use of aspirin