Should You Take Daily Aspirin? Simple Test May
Provide Scientific Answer
Study shows test may help doctors better determine
who will and will not benefit from use of aspirin therapy to prevent
May 10, 2014 - For years seniors, and even some
younger adults, have wrestled with the question of whether they should
take a daily aspirin. We know it offers cardiovascular protection, but
there is also the danger of excessive bleeding. There is even room for
wiggle in the American Heart Association’s recommendations. At last,
there may be a better option – a simple test providing scientific
evidence to help doctors in deciding their aspirin advice for patients.
For over 30 years, aspirin has been known to
prevent heart attacks and strokes, but who exactly should take a daily
aspirin has remained debatable. New research published in
Circulation: Cardiovascular Quality and Outcomes shows that your
coronary artery calcium (CAC) score, a measurement of plaque in the
arteries that feed the heart, may help determine whether or not you are
a good candidate for aspirin.
“Many heart attacks and strokes occur in
individuals who do not appear to be at high risk,” states lead author,
Michael D Miedema, MD, MPH., preventative cardiologist at the
Minneapolis Heart Institute at Abbott Northwestern Hospital and a
clinical investigator with the Minneapolis Heart Institute Foundation (MHIF).
“Individuals with known CVD (cardiovascular
disease) should take a daily aspirin, but the best approach for
individuals without known CVD is unclear. If we only treat high-risk
individuals with aspirin, we are going to miss a substantial portion of
patients who eventually suffer heart attacks.
“However, liberally prescribing aspirin increases
the bleeding risk for a significant number of people who were never
going to have a heart attack in the first place. With this study, we
wanted to see if there is potentially a better way to determine who to
treat with aspirin beyond simply using traditional risk factors.”
Aspirin helps prevent heart attacks and strokes by
preventing blood clots from forming in arteries lined with unhealthy
plaque buildup. However, this same benefit puts patients taking aspirin
at risk for dangerous bleeding, when blood clots don’t form where they
U.S. Preventive Services Task Force Recommendation
Current as of October
Aspirin for the Prevention of Cardiovascular Disease
• The USPSTF recommends
the use of aspirin for men age 45 to 79
years when the
potential benefit due to a reduction in myocardial
infarctions outweighs the potential harm due to an increase
in gastrointestinal hemorrhage.
• The USPSTF recommends
the use of aspirin for women age 55 to 79
years when the
potential benefit of a reduction in ischemic strokes
outweighs the potential harm of an increase in
• The USPSTF concludes
that the current evidence is insufficient to assess the
balance of benefits and harms of aspirin for cardiovascular
disease prevention in men and women 80
years or older.
• The USPSTF recommends
against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial
infarction prevention in men younger than
For that reason, the American Heart Association
(AHA) guidelines currently recommend aspirin to prevent cardiovascular
disease (CVD) in people who have known CVD or who are considered to be
at high risk for a CVD event. Aspirin is generally not recommended for
people who are considered to be at low or intermediate risk.
In this retrospective study, researchers studied
4,229 participants in the Multi-Ethnic Study of Atherosclerosis (MESA)
from six centers across the country. Participants included had no known
CVD or diabetes, were not on aspirin therapy, and were followed for
approximately 7 years.
Participants were grouped according to their CAC
score. The rates of heart attacks in each group were calculated. Based
on these rates, the research team weighed the likelihood of an
individual to benefit from aspirin therapy (the potential of the aspirin
to prevent a heart attack) against the likelihood of harm (the potential
for the aspirin to cause major bleeding).
They estimated that participants with elevated CAC
scores were 2 to 4 times more likely to benefit from aspirin therapy
than to be harmed, even if they did not qualify for aspirin use
according to current AHA guidelines. Conversely, MESA participants with
no calcified plaque (CAC score = 0) were 2 to 4 times more likely to be
harmed by aspirin use than to benefit. The results in both groups held
true even after accounting for traditional risk factors.
“We estimate that individuals with significant
plaque buildup in the arteries of the heart are much more likely to
prevent a heart attack with aspirin use than to suffer a significant
bleed” explains Miedema.
“On the opposite end of the spectrum, if you don’t
have any calcified plaque, our estimations indicate that use of aspirin
would result in more harm than good, even if you have risk factors for
heart disease such as high cholesterol or a family history of the
Miedema added, “A CAC score of zero is associated
with a very low risk of having a heart attack. That means individuals
with a score of zero may not benefit from preventive medications, such
as aspirin as well as the cholesterol-lowering statin medications.
“Approximately 50% of middle-aged men and women
have a CAC score of zero, so there is a potential for this test to
personalize the approach to prevention and allow a significant number of
patients to avoid preventive medications, but we need further research
to verify that routine use of this test is the best option for our
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