Aspirin to Prevent Stroke or Heart Attack

Primary prevention for stroke and heart attack. Find out if aspirin is right for you.

For some seniors, there's little room left in the medicine organizer on the counter. You might already have several pills and supplements to help keep you active and well. So, before adding another pill to the pill box, you want to make sure it's worth the effort and cost. Consider the risks and benefits of aspirin therapy for the primary prevention of stroke and heart attack.

Preventing stroke and heart attack is important for seniors, especially for those who have any of these risk factors for cardiovascular disease:

  • High cholesterol
  • High blood pressure
  • Diabetes
  • Overweight
  • Smoking

If you have one or more risk factors, your doctor may advise you to take low-dose aspirin (81 mg) daily to lower the risk of blood clots that can cause heart attack or stroke.

Aspirin helps prevent clots from forming. Clots are what cause most strokes and heart attacks. If you have no strong cardiovascular risk factors other than your age, or you have certain health problems that put you at increased risk for bleeding, the overall benefits of taking aspirin to prevent a first stroke or heart attack may not be clear cut.

Recommendations for primary prevention

Treatment to prevent a first stroke or heart attack is called primary prevention.

In the primary prevention of stroke or heart attack, there may be a delicate balance between the benefits and risks of any treatment. Aspirin therapy has risks, including serious bleeding in the stomach or brain. Bleeding in the brain leads to a different type of stroke called a hemorrhagic stroke.

When deciding whether to use daily aspirin therapy, you and your doctor will assess your risk factors for stroke and heart attack and weigh them against the chances you could have bleeding problems. Daily low-dose aspirin (81 mg) seems to help men and women differently:

  • In women, it cuts the risk of a first stroke.
  • In men, it lowers the risk of a first heart attack.

To get started, talk to your doctor to define your cardiovascular risk factors and determine your risk for problems like heart attack and stroke.

After reviewing your risk factors for stroke or heart attack, your doctor can advise you on whether aspirin therapy is right for you. When the benefits outweigh the risks, the U.S. Preventive Services Task Force (USPSTF) recommends daily aspirin therapy for:

  • Men age 45 to 79 to reduce the risk of heart attack
  • Women age 55 to 79 to reduce the risk of stroke

If you are over 80, there is not enough evidence for or against aspirin therapy. You and your doctor will need to carefully weigh the choice to continue or start daily aspirin. It is based on many factors, such as your overall health, whether you drink alcohol, and what other medications you are taking. For example, if you have liver or kidney problems, stomach ulcers, or bleeding disorders, aspirin therapy may not be safe for you.

Aspirin therapy for diabetics

The American Diabetes Association, the American Heart Association, and the American College of Cardiology offer more specific advice for people with diabetes.

They recommend low-dose aspirin therapy for people with diabetes who are at increased risk for heart disease and are not at increased risk for bleeding.

This includes men over age 50 and women over age 60 with at least one other major risk factor for heart disease. Major risk factors include smoking, high blood pressure, high cholesterol, a family history of early heart disease, and protein in the urine.

 

They also say that low-dose aspirin may be considered for some people in the following groups:

  • Younger people with diabetes who have at least one risk factor for heart disease
  • Older people with diabetes who have no other risk factors for heart disease besides diabetes

Some of these recommendations differ from the other major guidelines. If you have diabetes, talk to your doctor to learn if low-dose aspirin therapy is right for you.

Secondary prevention

If you've already had a stroke or heart attack, preventing another is called secondary prevention. This approach is well studied. Most people who have had either a stroke or heart attack are under aggressive treatment using medications or surgery.

Medications may include aspirin or other blood thinners to help prevent further heart attacks or strokes. Surgery options include carotid endarterectomy, which is removal of plaque buildup in the major arteries supplying blood to the brain. Coronary artery bypass surgery helps improve blood flow through arteries supplying the heart. In these groups, the benefits of treatment to prevent a stroke or heart attack tend to outweigh any of the risks of treatments.

A special case for prevention: atrial fibrillation and stroke

Atrial fibrillation (A-fib) is a heart rhythm disorder. It causes an irregular heartbeat. A-fib can raise the risk for blood clots in the heart that can break loose and lodge in the brain, causing a stroke. People with A-fib are about five times more likely to have a stroke than people who don't have it. For this reason, people with A-fib may need more powerful blood-thinning medications, such as:

  • Anticoagulants such as warfarin (Coumadin) and Pradaxa
  • Antiplatelets such as clopidogrel sometimes added to aspirin

But with the added "firepower" of these clot-preventing medications comes greater risk for bleeding. For most people with A-fib, though, the risk of stroke is higher than the risks of bleeding. People who take some anticoagulants may need to have their blood checked regularly and need to report any signs of bleeding to their doctor right away.

If you take any medicines that affect blood clotting, report any signs of bleeding to your doctor right away.