Sorting out aspirin's role in heart attack and stroke prevention

If you follow health news, you've probably noticed that conflicting medical advice seems to come out almost daily. A recent dispute that's received widespread coverage involves aspirin. For years, low-dose aspirin has been considered to be an important, and inexpensive, weapon in the arsenal to combat heart attack and stroke. Because of its anti-clotting properties, nearly 50 million people in the United States take either a daily low-dose (75–81 mg) tablet or higher (100–325 mg) to prevent or treat cardiovascular disease.

As an antiplatelet drug, aspirin reduces the stickiness of blood platelets, preventing them from clumping together and forming a blood clot that can lead to a heart attack. Organizations like the American Heart Association (AHA) and the American College of Cardiology (ACC) have been recommending taking a low-dose tablet daily for certain patients at increased risk of a first-time heart attack or stroke. This strategy is known as primary prevention.

However, in May 2014, the Food and Drug Administration (FDA) announced that no strong evidence supports the use of aspirin to prevent a first heart attack or stroke—especially in light of aspirin's known risk of serious bleeding in the stomach and, in rare cases, the brain—and now recommends against the general use of aspirin for primary prevention.

The FDA's position doesn't override the advice of your doctor. Instead, as it acknowledges in its statement, the recommendations are broad and state that the decision to implement aspirin therapy is best made by each individual patient and his or her doctor after a thorough discussion of aspirin’s risks and benefits.

The FDA reviewed relevant studies and found no sufficient support for primary prevention. The agency does point out, though, that the evidence it uses to make regulatory decisions may differ from those used by doctors for specific patients. Research into aspirin and its usefulness against first-time heart attacks and stroke is ongoing, and the FDA is keeping a close eye on what study results may produce.

Some people may be tempted to stop aspirin therapy suddenly after reading the FDA's stance. But if you're already taking a daily aspirin, don't stop without first talking with your doctor, particularly if you have a history of heart problems. According to a 2011 study in the journal BMJ, quitting aspirin cold turkey could trigger a rebound effect in people with cardiovascular disease that makes them more prone to a heart attack or death.

Doctor's Viewpoint

James L. Weiss, MD, Michael J. Cudahy Professor of Cardiology, Johns Hopkins University School of Medicine

The FDA's announcement will no doubt confuse some patients as to whether aspirin therapy will benefit them. This is where having a solid, trusting relationship and good communication with your doctor becomes crucial: No one knows you better than him or her, and your health history may show that a regular aspirin regimen could be beneficial to you. The FDA statement calls for more discriminate use of aspirin and serves as a reminder that the drug shouldn't be prescribed with a one-size-fits-all approach.

Because consumers can buy aspirin over the counter, many think it's harmless and take it without their doctors' guidance—yet aspirin can have serious adverse effects, as the FDA points out. If you're taking a daily aspirin without having had a discussion with your doctor about whether aspirin therapy is right for you, now is the time to start the conversation.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50; Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 16 Jun 2014

Last Modified: 28 Jan 2015