Research Asks If We Should Take Aspirin to Prevent Heart Attacks
STEVEN SANDBERG-LEWIS
ND, DHANP
Aspirin is one of the most common medicines worldwide. Initially synthesized from a natural compound in willow bark, it is now a highly purified and modified synthetic drug. Devoid of the health giving flavonoids and polyphenols found in willow bark, this synthetic form derives all of its action from acetylsalicylic acid (ASA), which reduces fever, pain and the clotting of blood. A mechanism behind these effects is the inhibition of an enzyme called cyclooxygenase which is an important step in inflammatory and clotting processes.
Since the late twentieth century, research has shown that ASA reduces the risk of heart attacks, although it has been shown to have a greater benefit in preventing a second heart attack than in preventing a primary incident. These research results apply to people from ages 40-59, not those over 60 years of age. In fact, the FDA has never approved the use of aspirin for primary cardiovascular prevention, which is the scientific term for prevention of a first heart attack.
In 2019, a meta-analysis of 13 studies found that if 241 people were to take aspirin everyday, or every other day, it would prevent one of those people from having an initial heart attack. With respect to preventing heart attacks in those who have already had one initial cardiovascular event, 361 people would have to take aspirin regularly to prevent just one of them from having a second heart attack. While these research outcomes do not look terrific, they could be interpreted as indicating some value in taking an inexpensive drug that could lead to reduced risk, until one considers the other risks.
As aspirin decreases clotting, it increases the risk of hemorrhagic strokes and gastrointestinal bleeding. If 210 people were to regularly take aspirin, it would cause one of them to have a major hemorrhage somewhere in the body. If 334 people were to regularly take aspirin, it would cause at least one of them to have a significant gastrointestinal hemorrhagic event.
A 2021 draft recommendation of the U.S. Preventive Services Task Force (USPSTF) says the following:
For men and women ages 40 to 59 years: The decision to initiate low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) in those who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small.
For men and women over age 60 years: The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in this age group.
Steven Sandberg-Lewis, ND, has been in clinical practice for 43 years, with a focus on functional gastroenterology. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. In 2019, Dr. Sandberg-Lewis co-founded Hive Mind Medicine, continuing his specialization in gastroenterology with a focus on reflux, SIBO, inflammatory bowel disease and functional GI disorders. He is currently working on his latest book, Let's Be Real About Reflux: Getting to the Heart of Heartburn, written to help non-medical and medical professionals alike develop a better understanding of diseases affecting the gastrointestinal tract.
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