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decision pointShould I take daily aspirin to prevent a heart attack or a stroke?

Aspirin, the common pain reliever, can prevent a heart attack or a stroke by keeping blood clots from forming in your arteries. People who have already had a heart attack or a stroke often take aspirin to help prevent another one. It's also suggested for people who have not had a heart attack or a stroke but are at risk of having one. This decision aid is for people who have not had a heart attack or a stroke.

Consider the following when making your decision:

  • Before you take daily aspirin, talk to your doctor. Aspirin can have bad side effects in some people. It's not a good choice for people who have a chance of bleeding, such as from a stroke caused by bleeding in the brain or from a stomach ulcer. Your doctor will look at whether you have a health problem that would mean you shouldn't take aspirin.
  • Daily aspirin is advised only for people who have a higher-than-average chance of having a heart attack or a stroke. Your doctor will find out if you are at high risk. Your risk may be high if you smoke, have high cholesterol, high blood pressure, diabetes, or a history of heart disease or stroke in your family. You can use this Interactive Tool: Are You at Risk for a Heart Attack? . Go over these results with your doctor.
  • Your doctor may advise you to take daily aspirin if the benefits to you outweigh the risks. Your doctor will also tell you what dose of aspirin to take. Most people take between 75 milligrams (mg) and 325 mg a day.
  • The benefits of daily aspirin are different for men and women. Your doctor will consider this in helping you decide whether to take aspirin.
  • Even if you take an aspirin every day, you still need a healthy lifestyle to lower your chance of a heart attack or a stroke. This includes eating healthy food, getting regular exercise, and not smoking.

How can a daily aspirin prevent a heart attack or a stroke?

Aspirin keeps blood clots from forming in your arteries. A blood clot in an artery in your heart can cause a heart attack. A clot in an artery in your brain can lead to a stroke.

People who have heart disease are at risk for a heart attack or a stroke. A fatty substance called plaque builds up in their arteries and narrows them. Sometimes a piece of plaque breaks open. Then a clot forms, because blood cells called platelets clump together to fix the tear. But if the clot blocks blood flow in a narrowed artery, it can cause a heart attack or a stroke.

Aspirin keeps the platelets from clumping together to form clots.

For more information on heart disease, see the topic Coronary Artery Disease.

For more information on stroke, see the topic Stroke.

Who can take daily aspirin?

Doctors advise daily aspirin for most people who have had a heart attack or a stroke. But they also suggest it for many people who haven't had a heart attack or a stroke but are at risk for having one. Things that raise your risk (called risk factors) include your age and whether your parents had a heart attack or a stroke. Having high blood pressure, high cholesterol, or diabetes also raises your risk.

Experts recommend aspirin for:1, 2, 3

  • Healthy men over age 40 who have one or more risk factors for heart disease, as long as their blood pressure is controlled and they have no reason not to take aspirin.
  • All healthy women over age 65, as long as their blood pressure is controlled and they have no reason not to take aspirin.
  • Women under 65 who have one or more risk factors for heart disease, as long as their blood pressure is controlled and they have no reason not to take aspirin.
  • Men and women over the age of 40 who have diabetes.

Daily aspirin isn't advised for people who have a low risk of a heart attack or a stroke.

Before your doctor has you take daily aspirin, he or she will find out if you have a high risk for a heart attack or a stroke. Your doctor will ask you questions about your health and your family's health. He or she also will do a physical exam and some tests, such as a blood test to check your cholesterol. Your doctor will use this information to find out what your risk is in the next 10 years.

If you know your blood pressure and cholesterol numbers, you can use an online tool to find out your risk of a heart attack. Show the results to your doctor so you can talk about whether aspirin might be a good choice for you.

Interactive Tool: Are You at Risk for a Heart Attack?

What are the benefits of taking daily aspirin?

Aspirin lowers the chance of a heart attack.4 It also lowers the chance of a stroke or a "mini-stroke," also called a TIA.5

Aspirin appears to work better in men to prevent a first heart attack. But it seems to work better in women to prevent a first stroke. The combined results of six studies showed that:6

  • About 8 first heart attacks were prevented for every 1,000 men who took aspirin. Aspirin didn't lower the chance of a heart attack in women.
  • About 2 first strokes were prevented for every 1,000 women who took aspirin. Aspirin didn't lower the risk of stroke in men.

Even if you take aspirin, you still need a healthy lifestyle to lower your chance of a heart attack or a stroke. This includes eating healthy food, getting regular exercise, and not smoking.

What are the risks of taking aspirin every day?

Daily aspirin is not right for everyone. People who have a risk of bleeding may not be able to take it. This includes people who have stomach ulcers or who have had a stroke caused by bleeding in the brain.

A stroke caused by bleeding in the brain is the most serious side effect of aspirin. This happens in 1 or 2 people out of 1,000 people who take aspirin. This also means that 998 to 999 out of 1,000 don't have a stroke caused by bleeding in the brain.7

Aspirin also can cause bleeding in the stomach or another part of the digestive tract. Bleeding that is bad enough to need treatment in a hospital happens in 2 to 4 people out of 1,000 who take aspirin. This means that serious bleeding doesn't happen in 996 to 998 of those people.7

Others who may not be able to take aspirin include people who:

  • Are allergic to aspirin.
  • Have high blood pressure that is not controlled.
  • Have asthma that is made worse by aspirin.
  • Have kidney problems.
  • Take the medicines warfarin (Coumadin) or clopidogrel (Plavix). They can raise the chance of bleeding. Doctors sometimes prescribe one of these medicines along with aspirin. If you need to take one of these medicines and aspirin, your doctor will tell you how to take them to lower the chance of bleeding.

Gout can become worse or hard to treat for some people who take a low dose (such as 75 mg to 325 mg) of aspirin.

If you can't take aspirin, your doctor may have you take clopidogrel (Plavix) to prevent a heart attack or a stroke.

How do you take aspirin?

Aspirin comes in different doses. The dose for daily aspirin ranges from 75 mg to 325 mg. One of the most common doses is 81 mg.

Although many people take aspirin every day, some people are advised to take it every other day. Your doctor will suggest what is right for you.

You can still take aspirin if you also take the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen regularly for arthritis or another problem. But if you take uncoated aspirin and ibuprofen at the same time, the aspirin may not work as well to prevent a heart attack. Try to take the ibuprofen at least 8 hours before or 30 minutes after you take an aspirin. Taking an ibuprofen once in a while doesn't keep aspirin from preventing a heart attack.

Experts don't know if other NSAIDs keep uncoated aspirin from working. They also don't know if people who take a daily coated aspirin should be concerned about ibuprofen or other NSAIDs. Talk to your doctor if you take these medicines every day.

Aspirin is low in cost, and you can buy it without a prescription. Generic and store brands work as well as brand names.

Your choices are:

  • Take an aspirin every day, along with leading a healthy lifestyle.
  • Don't take an aspirin every day. You may prefer to just lead a healthy lifestyle. You also may be able to take other medicines that lower your chance of having a heart attack or a stroke.

The decision whether to take a daily aspirin takes into account your personal feelings and the medical facts.

Deciding about taking daily aspirin

Reasons to take daily aspirin

Reasons to not take a daily aspirin

  • You have a risk factor for a heart attack or a stroke, such as heart disease, diabetes, kidney disease, high blood pressure, high cholesterol, or a family history of heart attack or stroke. Aspirin keeps clots from forming in your arteries and lowers the chance of heart attack and stroke.
  • You don't have any health problems that would be made worse by taking aspirin.

Are there other reasons you might want to take a daily aspirin?

  • You don't have a risk factor for a heart attack or a stroke, such as heart disease, diabetes, kidney disease, high blood pressure, high cholesterol, or a family history of heart attack or stroke.
  • You have a health problem that would make it hard to take aspirin, such as a stomach ulcer, allergy to aspirin, or asthma that is made worse by aspirin.
  • You are taking warfarin (Coumadin) or clopidogrel (Plavix).
  • Your blood pressure is not under control.

Are there other reasons you might not want to take a daily aspirin?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking a daily aspirin. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am at risk for a heart attack or a stroke because I have diabetes, high cholesterol, high blood pressure, or a family history of heart disease or stroke. Yes No Unsure
I have a bleeding problem, such as stomach ulcers. Yes No Unsure
I don't like to take medicines. Yes No Unsure
I am allergic to aspirin. Yes No Unsure
I have asthma that gets worse if I take aspirin. Yes No Unsure
I take warfarin (Coumadin) or clopidogrel (Plavix). Yes No NA*
I want to do everything I can to prevent a heart attack or a stroke. Yes No NA*

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not take a daily aspirin.

Check the box below that represents your overall impression about your decision.

Leaning toward taking a daily aspirin

 

Leaning toward NOT taking a daily aspirin

         
  • Coronary Artery Disease
  • Stroke
  • Coronary Artery Disease
  • Stroke

Citations

  1. Pearson TA, et al. (2002). AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation, 106(3): 388–391.

  2. Mosca L, et al. (2007). Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation, 115(11): 1481–1501.

  3. American Diabetes Association (2008). Standards of medical care in diabetes. Clinical Practice Recommendations 2008. Diabetes Care, 31(Suppl 1): S12–S54.

  4. Awtry EH, Loscalzo J (2000). Aspirin. Circulation, 101(10): 1206–1218.

  5. Lip GYH, et al. (2006). Stroke prevention, search date July 2006. Online version of Clinical Evidence (15): 1–27.

  6. Berger JS, et al. (2006). Aspirin for the primary prevention of cardiovascular events in women and men: A sex-specific meta-analysis of randomized controlled trials. JAMA, 295(3): 306–313.

  7. U.S. Preventive Services Task Force (2002). Aspirin for the primary prevention of cardiovascular events: Recommendation and rationale. Annals of Internal Medicine, 136(2): 157–160.

Author Marianne Flagg
Editor Katy E. Magee, MA
Associate Editor Michele Cronen
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Last Updated February 18, 2008

WebMD Medical Reference from Healthwise

Last Updated: May 01, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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