Aspirin
For decades, taking a daily low-dose aspirin (which many of us knew as “baby aspirin”) was nearly automatic for men over age 50. It was considered a safe way to protect against heart disease. As it turns out, this daily 81 mg dose is no longer recommended for the great majority of adults!
In 2022, the United States Preventive Task Force updated its guidance to recommend against using aspirin for primary prevention of cardiovascular disease in those over 60. The American Geriatric Society Beers Criteria (the gold standard list of medications that are potentially inappropriate for older adults) went even further by moving aspirin to a list of medications to actually avoid taking.
Why did this happen? For most of those who have never had a heart attack or stroke, the data found that the bleeding risks from aspirin, including gastrointestinal bleeding, outweighed the cardiovascular benefits.
What are the benefits of taking aspirin? It can be used for the short-term relief of headache, pain, and fever that occur as a result of colds, muscle trauma, arthritis, menstruation, and toothache. It lessens inflammation. For those with heart disease, it improves the flow of blood through arteries, and reduces the risk of another heart attack or stroke.
What are the downsides of taking a daily low-dose aspirin? For most between the ages of 18 and 60, the side effects will be greater than its benefits. These side effects can include stomach irritation, heartburn, nausea, tinnitus, excessive bruising and bleeding, hives, swelling of the eyes, face, lips, tongue, wheezing or difficulty breathing, hoarseness, rapid heartbeats, cold and clammy skin, bloody vomit, and bloody stools. It is not suitable for people with an allergy to NSAID medications. It is not recommended for children under 16.
Aspirin can also interact with several drugs, including other anticoagulants or antiplatelet agents, some glaucoma medications, corticosteroids, other NSAIDs, SSRI antidepressants, and thrombolytics, as well as some herbs, vitamins, and other supplements. Drinking alcohol can increase the risk of bleeding while on aspirin. Aspirin is not recommended during pregnancy.
Aspirin has been helpful for some 3,500 years for the treatment of pain, fever, and inflammation; cardiovascular health; and even cancer prevention. However, I recommend a careful risk/benefit analysis with your doctor.
