Hello, welcome to my channel Medicine with Dr. Moran. I'm a consultant in Internal Medicine.
Who should take Aspirin to prevent heart attacks and strokes? It's a question I get asked a lot by
patients. In today's video I'm going to review the U.S. Preventative Screening Task Force
recommendation guidelines on Aspirin, and the use of Aspirin to prevent first cardiac events like a
heart attack and secondary events for patients who have had a heart attack, a stent ,a bypass,
mini stroke, or stroke the answer is very clear that Aspirin itself will prevent future events.
This is what we call secondary prevention meaning that it's being utilized to prevent a second event
after surviving the first one. The dose of aspirin is a low dose which means a dose of 81 milligrams
here in North America or the 100 milligram dose often given in other parts of the world but not
the 325 higher dose, but what about taking aspirin to prevent a first event? Who should receive
Aspirin to prevent a first heart attack or stroke? This is what we call primary prevention or primary
prophylaxis. Over the last 30 years or so many people have taken Aspirin on a daily basis often
not on physicians advice but is it actually worth the risk? Often physicians would recommend aspirin
to adults over 50 who have a greater than 10% risk of a heart event over a 10-year period. There are
risk calculators that you can look up online to estimate your 10-year risk of cardiovascular
events which are based on criteria such as age, diabetes, high blood pressure, smoking,
and family history ,and of course lipid values, or cholesterol values. Now there's a link to the
description below to one of those calculators for those who are interested in finding their 10-year
cardiovascular risk. There are many ways you can reduce your cardiovascular risk by improving these
risk factors if they're abnormal or doing things such as eating a healthy diet, getting proper
amounts of sleep, and regular physical exercise. Aspirin is one medication that can relower the
risk further. The other medications that are widely used to reduce risk or cholesterol lowering
medications called Statins which in high-risk people who have had an event will reduce the
risk of another by 25% on average. Now this year the U.S. Preventative Services Task Force updated
their recommendations on the use of low-dose Aspirin for primary prevention of cardiovascular
disease and they did this by reviewing a large number of Trials including three recent ones.
One was looking at moderate risk adults in the ARRIVE trial. One was looking at diabetics in
the ASCEND trial, and one was looking at the elderly in the ASPREE trial. These trials all
three of them in summary essentially demonstrated that the risk of Aspirin causing bleeding negated
the small benefit in preventing heart attacks and strokes. There were hundreds of thousands
of patients in the numerous trials that they reviewed and Aspirin was associated with a 58%
relative risk increase in stomach and intestinal bleeds and a 31% increase in brain bleeding.
The absolute risk of bleeding on low-dose aspirin to begin with is about 0.2% a year
and would be approximately 0.1% per year without Aspirin. So these are small numbers but there's
no question that Aspirin does increase the risk of bleeding and that's the downside to
the medication. Now the bleeding was much more common in older patients as you might imagine.
I have personally seen ulceration in the stomach intestine and colon from Aspirin when scoping
people that are bleeding not to mention other sites of bleeding. Aspirin is associated with an
approximate 10 reduction in prevention of a heart attack so if you've got a 10% 10-year risk of
heart attack taking Aspirin reduces your 10% risk down to 9% which is what we call the 10% reduction
but of course this occurs at the risk of bleeding. So what were the task force recommendations? They
now recommend the decision to initiate low-dose Aspirin to prevent your first heart attack or
stroke in adults 40 to 59 who have a 10% or greater 10-year risk that should be an individual
decision between the patient and the doctor. This of course would assume a very low bleeding risk.
Bleeding risk would be that you would not be taking any anti-inflammatories like Advil,
Naprosyn, Motrin, not taking an anticoagulant, and have minimal alcohol consumption because
those would increase the risk of bleeding. So the recommendation here in that age group
is not a definite one it's one that should be discussed between patient and doctor knowing
that the benefit is small but it seems to outweigh the risk. Now there may be some
people in this age group who are worried because of a strong family history of heart disease and
who of other risk factors and they may choose to take Aspirin because they're more concerned
about heart attacks and stroke than bleeding. The recommendation for people older than 60 the risks
of taking Aspirin really negate the benefits and they felt in those that are taking Aspirin for
primary prevention there was little incremental benefit of continuing this beyond the age of 75.
Now if you're already taking low-dose Aspirin for primary prevention you should discuss
whether you should continue with your doctor in light of these recent recommendations.
So let me summarize if you're on Aspirin because you've already had a heart attack, a stent,
a bypass, mini stroke, or stroke, keep taking Aspirin to prevent a secondary event. If you've
never had a first event and you're wondering about taking Aspirin well if you're in the 40 to 59 year
old age group and you've got a 10-year risk of 10% or more talk to your doctor about whether
the small benefits that I've described are worth the risks in your particular situation. If you
have never had a first event and you're older than 60 the benefits really are negated by the risks.
This guideline does not definitively recommend Aspirin for primary prevention for any group of
adults. That's something to remember. The vast majority of specialists who care for people with
cardiovascular disease like myself in general tell people that you don't need to be on aspirin unless
you've had a cardiovascular event, mini stroke, or stroke. It's important for anyone to reduce their
risk of a cardiovascular event by getting regular exercise, good quality sleep, eating a healthy
diet, losing weight if needed, and optimizing other risk factors. Thanks a lot for joining
me today on Medicine with Dr. Moran. I'm Dr Keith Morin and remember get healthy and stay healthy.