Daily Aspirin: Do Risks Outweigh Benefits?

Taking a daily low-dose aspirin can help prevent heart attacks or clot-related strokes in people with heart disease or a prior heart attack or stroke, but a recent report suggests that the risks of a daily aspirin regimen might outweigh the benefits in those without a history of these conditions.

The research, led by a panel of experts in the United Kingdom, looked at two large studies of people with diabetes and found that those who took 81–100 milligrams of aspirin daily were just as likely to have a heart attack or stroke within the next four to seven years as those who did not. And although aspirin can thin the blood and prevent blood clots, which cause roughly 80% of strokes, this medicine might increase the risk for hemorrhagic strokes (caused by bleeding in the brain) and gastrointestinal complications such as ulcers.

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Roughly 50 million Americans, including some who do not have heart disease or a history of heart attack or stroke, take low-dose (325 milligrams daily or less) aspirin to prevent cardiovascular problems, an approach known as primary prevention. The American Diabetes Association (ADA) currently recommends a low-dose aspirin regimen for primary prevention in people with diabetes, who are at increased risk for cardiovascular disease.

However, this recommendation may soon be changing. According to M. Sue Kirkman, MD, Vice President of Clinical Affairs for the ADA, “Because of some recent studies suggesting that the benefit is not very large, and because aspirin can also have risks (intestinal bleeding or hemorrhagic stroke), the January 2010 [ADA Clinical Practice] Recommendations will recommend it mostly for higher-risk people than was the case in the past, when it was recommended for people with more moderate levels of risk and above.”

Nonetheless, Dr. Kirkman stresses that people who are taking aspirin should have a discussion with their doctor before making any changes to their aspirin therapy, noting that “There isn’t a strong rationale to take people off [aspirin] if they’re doing fine.”

To learn more, read the article “Risks of Daily Aspirin May Outweigh the Benefits” or see the study’s abstract in the Drug and Therapeutics Bulletin.

  • diabetes

    I agree. If the patient is not affected with the aspirin taking, maybe it’s fine. Maybe a regular check-up is a good exercise.

  • Joan Kelly

    I have a dilemna. Have talked to my doctor about taking a baby aspirin which I take daily and I am also on omeprazole two times a day. I have serious digestion problems which cannot be corrected. I was on plavix and am not taking it anymore because the ppi causes problems with the effectiveness of the plavix. What are my options.

  • Laura W

    Joan,
    I know it seems confusing, but the best thing you can do is maintain good communication with your doctor about your conditions. Each of us is unique and the guidelines that are generalizations for everyone may not apply to you. Just ask your doctor questions and make sure you get clear answers. Don’t let general suggestions stress you out.

  • Diane Fennell

    Hi Ms. Kelly,

    Thank you for your question.

    I’d like to reiterate what Laura noted — general guidelines are just that, and only you and your doctor can determine what is appropriate for you individually. Since your physician is familiar with the specifics of your situation, I would encourage you to have another discussion with him about what types of treatment might work best.

    I wish you luck and thank you for your interest in Diabetes Self-Management.

    Best,
    Diane Fennell
    Web Editor

  • G V Rao

    People who are having Diabetes ( no cardiac disease) like myself are at a fix what to do whether to take prescribed Asprin (Ergosprin) or not daily. When approached to personal doctor his opinion is to continue daily the prescribed dosage of Asprin. But the risk involved for those who are suffering from Diabetes and no cardiac disease is really worrisome. Only an expert should give definite opinion on this . Till that time we have to take the risk of intestinal bleeting and Brain heamorrage

  • Mark Gottlieb

    I’ve had this issue for quite some time with most of my docs (I’ve moved a few times in the last dozen years, always had pretty good PCPs). Since being exposed to Barry Sears and his Zone diet nutrition, I’ve thought that daily fish oil (Omega 3 fat supplement) made more sense than a daily aspirin. Both aspirin and fish oil have modulating impacts on the prostiglandin system – locally acting hormones that modulate constriction, relaxation, and aspects of inflamation.
    The omega 3s down-regulate the constrictive/inflamatory PGs, while aspirin pretty much down-regulates the entire PG system. So I’ve always opted for the daily omega 3 supplement vs. the daily aspirin. I heard in a talk recently from a U Wash Endocrinologist that this might become a new diabetes care guidelines recommendation.

    Mark Gottlieb, PhD
    Epidemiologist

    “Good advice costs nothing and its worth the price!” – Allan Sherman

  • marcy clark

    I had a 4CABG aproximatly 10 days following being diagnozed for diabetes in 05. I have been on baby asprin and a host of cardiac medications since then, all told I take 16 seperate pills a day. Plavix is one of them. I also take Omega 3 suppliments. I don’t know if it is working I only can say I am still alive, and althought my complications from diabetes continue to “evolve” I feel pretty good.

    This is such a double edge situation. Following your doctors orders is the most prudent. This is the first that I have read about the brain “issue”, I find it of interest, but… not worth tinkering with what is working well so far.