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Daily aspirin therapy: Understand the benefits and risks

Is an aspirin a day the right thing for you? It's not as easy a decision as it sounds. Know the benefits and risks before considering daily aspirin therapy.

By Mayo Clinic staff

Daily aspirin therapy helps lower the risk of heart attack and stroke, but daily aspirin therapy isn't appropriate for everyone. Is it right for you?

You should consider daily aspirin therapy only if you've had a heart attack or stroke, or you're at high risk of either. And then, proceed only with your doctor's approval. Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects.

How does aspirin prevent a heart attack or stroke?

Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, accumulate at the site of your wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.

But this clotting can also happen within the vessels that supply your heart and brain with blood. If your blood vessels are already narrowed from atherosclerosis — the accumulation of fatty deposits in your arteries — a blood clot can quickly form and block the artery. This prevents blood flow to the heart or brain and causes a heart attack or stroke. Aspirin therapy reduces the clumping action of platelets — possibly preventing heart attack and stroke.

Does daily aspirin therapy differ between men and women?

Early studies on daily aspirin therapy were done mostly in men. More recent studies have focused on the effects of aspirin in women, finding that its effects differ between the sexes, and for women, between age groups. The table below shows how aspirin can affect men and women differently.

Aspirin benefits for men and women

A daily aspirin can: Women under age 65 Women age 65 and older Men (all ages)
Prevent first stroke X X  
Prevent first heart attack   X X
Reduce heart disease risk X X X
Prevent second heart attack X X X

The risk of bleeding with daily aspirin therapy, however, is about the same in both sexes. More study is needed to determine how or if this might change recommendations for daily aspirin therapy for heart attack and stroke prevention.

Should I take a daily aspirin?

Whether you need daily aspirin therapy depends on your risk of heart disease and stroke. Risk factors for a heart attack or stroke include:

  • Smoking tobacco
  • High blood pressure — a systolic pressure of 140 millimeters of mercury (mm Hg) or higher or a diastolic pressure of 90 mm Hg or higher
  • Total cholesterol level of 240 mg/dL (6.22 mmol/L) or higher
  • Low-density lipoprotein ("bad") cholesterol level of 130 mg/dL (3.68 mmol/L) or higher
  • Lack of exercise
  • Diabetes
  • Stress
  • Having more than two alcoholic drinks a day for men, one drink a day for women
  • Family history of a stroke or heart attack

If you've had a heart attack or stroke, chances are your doctor has talked to you about taking aspirin to prevent a second occurrence.

If you have strong risk factors, but have not had a heart attack or stroke, you may also benefit from taking an aspirin every day. First, you'll want to discuss with your doctor whether you have any conditions that make taking aspirin dangerous for you.

Some conditions that may prevent you from starting daily aspirin therapy include:

  • A bleeding or clotting disorder (bleeding easily)
  • Asthma
  • Stomach ulcers
  • Heart failure

It's also important to tell your doctor what other medications or supplements you might be taking, even if it's just ibuprofen. Taking aspirin and ibuprofen together reduces the beneficial effects of the aspirin. Taking aspirin with other anticoagulants, such as warfarin (Coumadin) could greatly increase your chance of bleeding.

What's the best dose of aspirin to take?

There's no uniform dose of aspirin you should take to get the benefits of daily aspirin therapy. You and your doctor will discuss what dose is right for you. Some studies have shown that very low doses of aspirin — 75 milligrams (mg), which is less than a standard baby aspirin — can be effective. Your doctor may prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (regular strength).

What happens if I stop taking aspirin every day?

While you might know that taking daily aspirin helps prevent additional heart attacks or strokes, you might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack or stroke. If you've been on daily aspirin therapy and want to stop, it's important to talk to your doctor before making any changes. Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot.

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HB00073

Aug. 27, 2008

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