If you are considering daily aspirin therapy, you may already know that it has the potential to lower your risk of heart attack or stroke. What you might not know is that long-term use of daily aspirin therapy isn’t right for everyone and may cause health problems under certain circumstances. This article is not meant to replace the advice of your health care professional, but will provide an overview on the use of aspirin therapy. Use this article to help you form your own questions about the pros and cons of daily aspirin use and take those questions with you when you visit your doctor.

What is aspirin made of?

Aspirin, also known as acetylsalicylic acid, is a term for medication most commonly used to treat pain, fever, inflammation, heart attack or stroke. Other uses are still being studied, including for treating certain kinds of cancer and Alzheimer’s Disease.

The Lancet study recently found that a daily aspirin appeared to lower the risk of certain cancers by at least 20 percent during a 20-year period. That’s based on data from more than 25,000 patients and builds on earlier findings that aspirin may lower the risk of colorectal cancer. The report acknowledged that the research had limitations, but it does add another benefit to an ancient remedy. So where does this “miracle drug” come from?

You may be surprised to discover that the origin of aspirin is natural. The leaves and bark of certain species of the willow tree have been used for thousands of years to create this medicine. Salicylic acid is also found in jasmine, beans, peas, and clover. Vegetables with salicylic acid content greater than 5 mg per 100 g of food include green pepper, olives, mushrooms, tomato, radish and chicory. Other vegetables rich in salicylates include alfalfa, broccoli, cucumber, fava beans, spinach, and sweet potato.

Even the earliest doctors knew about the benefits of aspirin, although they would not have called it by that name. Hippocrates, the famous Greek physician (460 to 377 B.C.) wrote that willow leaves and bark relieved pain and fevers.  It was not until 1899 that a popular brand in the United States named it “aspirin” and sold it around the world.

Aspirin as heart medicine

Although it might be argued that aspirin is used most often to bring a fever down, aspirin’s uses for heart patients came to light in 1948 when California physician Dr. Lawrence Craven recommended an aspirin a day to reduce heart attack risk, based on what he had observed in patients.

In fact, the Nobel Prize in medicine in 1982 was awarded to researchers who demonstrated the reason why aspirin was beneficial to heart patients. In layman’s terms, aspirin inhibits production of hormones called prostoglandins. Prostoglandins are responsible for the formation of clots that lead to heart attacks and strokes, and aspirin prevents that clotting from happening.

Because this therapy is so effective, patients who experience a heart attack or stroke are often prescribed a daily aspirin unless they have health issues that prevent them from being a good candidate for this treatment, such as a serious allergy or history of internal bleeding.

If you have a high risk of having a first heart attack, your doctor will likely recommend aspirin after weighing the risks and benefits.

Risks and benefits of daily aspirin therapy

Taking an occasional aspirin or two is almost a universal experience. That’s why that old saying “Take two aspirin and call me in the morning,” is proverbial for doctor’s advice. Taking a few occasional aspirin is safe for most adults to use for common headaches, body aches, or fever. But the very characteristics of aspirin’s beneficial use can become problematic with long-term use. In some cases, daily use of aspirin can have serious side effects, including internal bleeding. This is why it is important to consult with your physician, discuss your medical history, and never start daily aspirin therapy on your own.

How does aspirin work?

Aspirin interferes with the body’s blood clotting action. When a person bleeds, blood cells known as platelets build up at the site of the wound. The platelets help form a plug (also known as a scab) that seals the opening in the blood vessel and if all goes well, stops the bleeding.

This clotting action can happen anywhere. In fact, it can also happen inside blood vessels that supply the heart with blood. When a person already has cholesterol problems, blood vessels are narrowed from atherosclerosis. If a blood clot forms here and blocks the already-clogged artery, it causes serious problems in the circulation system. This blockage prevents blood flow to the heart and causes a heart attack. Aspirin therapy in this case reduces the clumping action of platelets, and the idea here is that the blood flows better, preventing a heart attack.

It is important that patients discuss their medical history honestly with healthcare providers so that the information can be recorded for future visits. If your parents or anyone else in your family has a history of heart disease, talk with your doctor about whether daily aspirin therapy might help you prevent a heart attack.

According to the Mayo Clinic, persons who might be good candidates for daily aspirin therapy include:

–Patients who have already had a heart attack or stroke.

–Patients who have had a stent placed in a coronary artery, had coronary bypass surgery, or have chest pain due to coronary artery disease (angina).

–Patients who have diabetes and at least one other heart disease risk factor including smoking or high blood pressure.

Daily aspirin not recommended for younger patients

The way aspirin is prescribed may vary between healthcare professionals, but daily aspirin therapy is most often recommended for patients over 50 years of age who are not persons with increased bleeding risk.

Note: Aspirin is not approved for children younger than two years old and should be used with caution in teenagers because of a possible link to a condition called Reye’s syndrome. This is a complicated topic and deserves an article all by itself. For purposes of clarity, however, it should be mentioned that young people usually already have good blood flow and would not benefit from any medicine to decrease the blood’s ability to make a clot.

Certainly more research is needed to determine the benefits and risks of daily aspirin use in adults that are any younger than age 50 or older than age 70 before a recommendation can be made for or against daily aspirin use.

Although aspirin has been recommended in the past for certain groups of people without a history of heart attack, there’s still some disagreement, even among the experts, about whether the benefits of aspirin outweigh the risk factors.

Low doses of aspirin are effective

Some of the ways that healthcare professionals work to minimize the risks associated with daily aspirin use include lower doses and coated aspirin products.

Very low doses of aspirin, known as “baby aspirin” are 81 mg pills. Low-dose aspirin is considered safe and just as effective as the standard adult dose of 325 milligrams. When a drug has serious side effects, as aspirin does, healthcare professionals want to exercise caution and prescribe the lowest effective dose.  

When you purchase aspirin, you may notice something on the label that indicates the product (usually in tablet form) has been coated. Coated aspirin is designed to pass through your stomach without dissolving. The medicine is not expected to fully disintegrate and enter the bloodstream until it reaches your small intestine. This is thought to be gentler on the stomach and may be appropriate for some people who take a daily aspirin, especially in those with a history of gastritis or ulcers.

Other products deliver aspirin in a tablet that dissolves in the mouth and is absorbed directly into the blood, bypassing the stomach. That may make these products less likely than swallowed or even coated aspirin to directly irritate the stomach. Even this type of aspirin could still pose some risk since aspirin in the bloodstream blocks production of substances that protect the stomach lining. And all aspirin thins the blood, which increases the risk of bleeding.

Some medical professionals maintain that there isn’t enough evidence to prove that taking any type of aspirin really decreases your chance of developing gastrointestinal bleeding. Some research has found that newer forms of aspirin may not be as effective as plain aspirin when taken at the time of a possible heart attack.

Other risks associated with aspirin therapy

If you have been taking daily aspirin therapy and want to stop taking your medication, it’s important to talk to your healthcare professional before making any sudden or drastic changes. Suddenly stopping a daily aspirin therapy program (or any medication programs) could have negative consequences. It may even trigger a blood clot that could lead to a life-threatening heart attack.

Other risk factors of aspirin therapy are identified in persons who are already taking a medicine with similar effects. Both aspirin and nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Motrin IB, Advil, others) and naproxen sodium (Aleve), reduce the clotting action of blood platelets. Regular use of nonsteroidal anti-inflammatory medications can increase your bleeding risk.

While daily aspirin can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (hemorrhagic stroke). Daily aspirin use increases your risk of developing a stomach ulcer. If you have a bleeding ulcer or bleeding anywhere else in your gastrointestinal tract, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent.

Allergic reactions can happen with aspirin. If you’re allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction.

If you’re taking aspirin and need a surgical procedure or dental work, be sure to tell the surgeon or dentist that you take daily aspirin and how much. Your aspirin therapy is going to be making your blood flow easily, and this is not something you want to happen when you visit the dentist or surgeon.  You risk excessive bleeding during these procedures.

Problems in the mix

People who regularly take aspirin and drink alcohol can have an increased risk of stomach bleeding. If you choose to drink alcohol, do so in moderation. Again, this is because the effect of alcohol in the blood is going to be similar to that of aspirin.

Medical experts say that moderate amounts of alcohol can benefit blood flow in the human body by keeping the blood vessels free of the fatty deposits known as atherosclerotic plaque.  This buildup causes a condition known as atherosclerosis. Sometimes these deposits in arteries don’t just form inside the blood vessel walls but inside the structure of the arteries themselves.  As plaque builds up, the artery wall gets thicker and thicker when the deposits are not washed out. This narrows the opening, reduces blood flow even more and decreases the supply of vital oxygen to cells. This slows down the entire circulatory system, and can be life-threatening.

If you’re already taking any medication that is anticoagulant (something to make the blood flow more easily) for another condition, combining it with aspirin may greatly increase the risk of major bleeding complications. Your full medication list needs to be considered in light of your aspirin therapy. As always, this needs to be discussed with your healthcare professional and pharmacist.

Keep in mind that herbal supplements, while completely natural, may be designed to act on the body’s ability to circulate blood. If it adds to the effectiveness of an aspirin, the increase may be too much, leading to a significant risk of internal bleeding.

At the time of this writing, it is estimated that over 500 different drugs are known to interact with aspirin. Make sure you bring the complete list of any medications you are taking when you visit your healthcare professional to discuss the benefits and risks of daily aspirin therapy.