The Aspirin Debate

by Dr. Julian Whitaker
Filed Under: Heart Health
Last Reviewed 02/06/2014

Aspirin is an excellent, inexpensive therapy, and its cardiovascular benefits are backed by hundreds of studies and decades of clinical use. I’ve received many questions about aspirin for cardiovascular protection, and most people assume I’m against it because it’s a drug and I always recommend going the natural route first.

Recently on my Facebook page I asked people whether they “Liked or Disliked” aspirin for heart protection. My previous “Like or Dislike” topics included hyperbaric oxygen therapy (HBOT), Sudoku , and saunas, all of which received an overall “like” reception. However the reception for my most recent “Like or Dislike” on aspirin was a bit more polarizing.

Some of the “dislike” comments cited the negative side effects of aspirin, including the fact that some individuals may be allergic to the drug, and it can cause (potentially severe) gastrointestinal (GI) bleeding and ulcers. But let’s set the record straight.

Large clinical trials spanning many years have found that:

1. For people who’ve had a heart attack, stroke, or TIA (“mini-stroke”), low-dose aspirin (81 mg per day) reduces the likelihood of a repeat cardiac event.

2. Regular use of low-dose aspirin lowers risk of a first heart attack in men and stroke in women (except those with diabetes, according to recent research).

3. Aspirin improves outcomes when taken during a heart attack or after angioplasty or bypass surgery.

That being said, I want to clarify that aspirin isn’t for everyone. Although it protects against ischemic stroke, it slightly increases risk of the less common hemorrhagic stroke, so it shouldn’t be taken by anyone with a bleeding disorder. Nor should it be taken during viral illnesses—especially by children and teens—because it is associated with potentially fatal Reye’s syndrome.

Last but not least, aspirin interacts adversely with some drugs, so it’s best to talk to your doctor first if you’re taking any medications. (For example, it increases the activity of blood thinners such as Coumadin, and its cardiovascular benefits are negated by ibuprofen.)

So, how much should you take?

The recommended dosage of aspirin ranges from 81 mg (the amount in baby aspirin) to 325 mg daily. For most folks, 81 mg per day should do the trick.

However, a fair number of people do not respond to aspirin’s protective effects at low dosage levels. “Aspirin resistance” affects about a quarter of the population with cardiovascular disease. Whether this is due to diabetes, genetic variations, or advanced disease is unknown. However, it’s clear that not everybody metabolizes aspirin the same way. An effective dose for me might not be enough for you, or it might be too much and cause bleeding.

A company called AspirinWorks offers a test that measures urine levels of a metabolite of thromboxane, which is the target of aspirin. This test will detect any degree of aspirin resistance and help you determine your proper dose. Talk to your doctor about the test, or find out how to order it yourself at aspirinworks.com.

Now, it’s your turn: Do you take daily aspirin for heart protection? If so, what’s been your experience?

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