News reports of the death of aspirin are exaggerated.

Late last year a number of news reports seemed to say the aspirin doesn’t work to improve health or prevent adverse health events.  Like the one linked above, these stories presented the truth about aspirin based on several studies published in the New England Journal of Medicine.  But the headline that too many people heard or believed was “aspirin doesn’t help so stop taking it.”

A bunch of my patients called and said that they were worried and were stopping aspirin based on these reports in the media.  Most times they didn’t hear the whole story.

The NEJM studies were looking at otherwise healthy older people taking aspirin just for possible pure health benefits (such as preventing a first heart attack or lowering the risk of cancer.)  This is the group in which aspirin was not beneficial.  We call that “primary prevention.”  Meaning, treat the common disease before it shows itself.  Aspirin doesn’t work for this concept, or at least we’ve never proven that it does and these studies support that lack of benefit.

My patients, most of whom are on aspirin following a stroke or TIA, are in a different situation, called “secondary prevention.”  Secondary prevention means there’s been a stroke, or heart attack or claudication (artery blockage) in the legs and we’re trying to minimize the risk of further problems.  For this, aspirin remains a mainstay in long term treatment.  The risk is higher because the disease has declared itself, and so the benefit of a treatment with a small risk (bleeding) is worth it.

We can tolerate a low risk of bleeding if the aspirin has a good effect for reducing the chance of another stroke.  Aspirin reduces these problems by making the blood less likely to clot.  When you diminish clotting, you increase bleeding.  In all comers without a high risk of clotting, even that small risk of bleeding doesn’t make sense.

So what do we do for primary prevention?  Control blood pressure, lower cholesterol, treat diabetes, eat a health diet, exercise and avoid obesity, don’t abuse alcohol and don’t smoke.

Of course every person is different and there may be some situations in which aspirin as primary prevention may be reasonable.  This is best discussed with your doctor to figure out what makes the most sense to you.

Here are links to the NEJM articles.

Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly

Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly

-DS (5-25-19)