Q. I am considering taking a low-dose ASA since an old saying I recall from decades ago said “an Aspirin a day keeps the doctor away” . My partner said I should consult with a healthcare provider first. Why is that necessary when it is available over the counter and it is such a low-dose?
A. Your partner is correct and very wise to suggest this. Consulting a healthcare provider before starting a daily low-dose ASA (acetylsalicylic acid, commonly known as Aspirin) is very important, even though it’s available over the counter.
For decades, ASA was routinely recommended to prevent heart attacks and strokes. You’ve likely heard sayings like “an Aspirin a day keeps the doctor away” because there was a time when doctors advised most older adults to take one each day for their heart health. However, in recent years, thanks to ongoing research in this area, our understanding of the benefits and risks of ASA has evolved significantly.
The idea behind taking ASA preventatively was due to its ability to reduce the risk of your blood clotting. This in turn can lower your risk of heart attack or certain types of stroke caused by blood clots. That makes perfect sense.
Now you might be wondering why the push back away from taking ASA daily. Well, unfortunately, while you are taking this to reduce your risk of blood clots, you are also increasing your risk of bleeding which can result in serious internal bleeding, stomach ulcers or even bleeding in the brain. These risks are possible even from the low-dose (81mg) ASA tablets. Thus, it became clear that taking ASA daily may not be practical for primary prevention of heart disease or stroke. Primary prevention means that you have not yet (and hopefully never), suffered a heart event or a stroke but that you are hoping to prevent it from occurring in the first place. That is great that you are looking to find ways to improve your health and ward off these conditions that can prove to be very debilitating for yourself and often your loved ones as well.
Rather than taking a low-dose ASA each day which might increase your risk of an internal bleed, you are best to look at lifestyle changes to reduce your risk such as;
· Exercise
· Adopting the Mediterranean diet
· Avoid highly processed foods and eating fast foods
· Stop smoking if you are a smoker
· Avoid or reduce alcohol consumption
· Improve your sleep routine
These healthy habits will not only aim to reduce your overall risk of heart disease and stroke but studies also show a reduction in dementia and cancer risk. More on that in a future column so stay tuned. Getting back to taking ASA, it is strongly recommended to NOT take ASA for this primary prevention as the risk of bleeding does not outweigh the potential benefits for the majority of us.
However, if you have already had the unfortunate experience of a heart attack or certain types of stroke, then you are at a much higher risk of experiencing another heart event. At this point, you may be prescribed ASA to prevent a second heart event and thus it is termed secondary prevention. However, if you have had a previous heart attack or stroke and after reading this column you realize you are not on ASA, do not rush out to purchase them to start taking. If you have had a heart event in the past and are not on ASA, your regime of medications you now take every day likely includes blood thinners or anti- platelets to reduce your risk. Once again, consult your health care provider if you are unsure.
So, should anybody be taking ASA for primary prevention? Over the last few years, organizations like the Canadian Cardiovascular Society, and the American Heart Association have updated their guidelines and now recommend against routine daily ASA for most adults over the age of 60 who have not previously had a heart attack or stroke. Not surprising to learn this since we are now aware of the increased risk of bleeding that outweighs the potential benefit.
For adults between 40 and 59 years old, ASA may have a slight benefit for people that are at a higher risk of heart disease and also have a low bleeding risk. This decision should only be considered with guidance from their healthcare practitioner. During their assessment, they will consider the following;
· Your age (bleeding risk rises with age)
· Personal and family history of heart disease or stroke
· Other health conditions, like diabetes, high blood pressure, or ulcers
· Medications you take, such as blood thinners, anti-inflammatories, or steroids, which can increase bleeding risk
· Lifestyle factors, like alcohol use or smoking
Sometimes, rather than initiating a low-dose ASA regimen for you, they may offer other strategies to help reduce your risk such as controlling blood pressure, cholesterol, or blood sugar. These may offer more benefit with less risk than daily ASA. This, along with the lifestyle changes listed above can help reduce your risk immensely.
The bottom line is that you should not start taking ASA without consulting someone from your healthcare team. Even though it is easily accessible to purchase and you do not need a prescription for it, it is strongly recommended to let your pharmacy know if you are taking it on a regular basis. They can document it on your records which helps to manage drug related concerns or interactions with other medications and/or medical conditions.
You may be wondering if you should keep ASA in the home in the event you do experience symptoms of a heart event. First off, if you think you might be having a heart attack, call 911 immediately and sit down so you do not exert your heart any further.
As for taking ASA, there was a time that it was routinely suggested to chew 2 low-dose (81mg) ASA tablets at the first sign of a potential heart attack, providing you have been cleared to take ASA and are not allergic to it. Though most organizations would continue to recommend this protocol, there are some that remain cautious and suggest to wait until you are advised to take ASA by paramedics or other first line health professionals. It is not uncommon for people to think they are experiencing a heart attack and it turns out to be something else entirely and ASA might aggravate the condition. Or a sudden pain in your chest could be the result of a tear in your aorta and taking ASA might worsen the situation.
Lastly, if you thought you might be having a heart attack and you did take ASA immediately, your symptoms may have subsided. Do not take this as a sign that you no longer need to get assessed. Chances are you did experience a heart attack and the ASA was able to ease some of your discomfort but this would only be a temporary solution. Be sure to be seen ASAP by medical staff who can perform an electrocardiogram (ECG) and other diagnostic tests.
For more information on this or any other health related topic, contact your pharmacist.
