Talk to your doctor first!
The New England Journal of Medicine (NEJM) published a study last week that shows the risks of a daily baby aspirin may outweigh the benefits, at least in patients older than 65.
I’ve known a lot of people, however, who started taking a daily baby aspirin on their own, without checking with their health care providers first.
Over the last few years there have been lots of stories in the media about the health benefits of a daily baby aspirin, such as lowering heart attack or stroke risk, or preventing colon cancer or dementia.
Those are some scary health problems; and why shouldn’t we trust a common, inexpensive drug that has baby* in its name?
But aspirin is a drug, and although it definitely has a place in medicine as a fever reducer, pain reliever, anti-inflammatory and blood thinner, it’s not safe for everyone and shouldn’t be used carelessly.
The risks of daily low-dose or baby aspirin
Aspirin belongs to a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs).
Like other NSAIDs (ibuprofen and naproxen), stomach irritation is the most common side effect.
Because it’s a blood thinner, serious bleeding in the stomach, intestines or brain is the most dangerous risk of taking daily aspirin.
The NEJM study actually found that the group of participants taking aspirin were more likely to die overall—not just from bleeding problems—than the group taking a placebo. This is called “all cause mortality.” The researchers couldn’t explain it, but this finding certainly influenced their conclusion that for older, healthy people, “the daily use of aspirin did not provide a benefit.”
Who should consider a daily baby aspirin?
Not all doctors are on the same page when it comes to low-dose aspirin. Some will be more quick to prescribe it than others.
Related post: Overuse of baby aspirin
The best evidence we have to date shows that although low-dose aspirin might be helpful in preventing a second heart attack or stroke (secondary prevention), it is not as helpful in preventing the first one (primary prevention).
A few years ago, Bayer Healthcare, which makes many aspirin products, petitioned the Food and Drug Administration (FDA) to get permission to market its low-dose aspirin as a primary prevention.
…after carefully examining scientific data from major studies, [the] FDA has concluded that the data do not support the use of aspirin as a preventive medication by people who have not had a heart attack, stroke or cardiovascular problems, a use that is called “primary prevention.” In such people, the benefit has not been established but risks—such as dangerous bleeding into the brain or stomach—are still present.
However, the United States Preventive Services Task Force (USPSTF) does recommend daily aspirin for primary prevention of heart disease and colon cancer in adults aged 50-59.
The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
It’s possible this new study may change the task force’s recommendation when it’s updated in a few years.
For now, the best advice is to NOT take daily low-dose aspirin without the approval of your health care provider.
If your doctor does advise daily low-dose aspirin, ask questions to make sure you understand why it’s being prescribed and that you’re comfortable the benefit will outweigh any potential harms.
*FYI, the term “baby” aspirin began decades ago when it was still common to give aspirin to infants and small children. The typical baby tablet, 81mg, is a fraction of the normal adult dose of 325mg. Since the late 70s, however, aspirin has not been recommended for babies and children because of the risk of developing a particular liver disease, Reye’s Syndrome.