Q: What are the benefits or dangers of long-term aspirin use for stroke prevention?
If it is of benefit, what does it actually do, and if it is not a good idea, why?
A: Aspirin is probably the most widely used over-the-counter drug in America. Besides its occasional use for headaches, minor arthritis pain and body aches, it is often used in preventing heart attack and stroke, especially in individuals with established coronary artery disease. This is called secondary prevention. It helps to reduce inflammation and thin out the blood which can lower the chances of another infarct. Unfortunately, daily aspirin use can have some unpleasant side effects such as tinnitus.
I am bothered by the fact that most people prescribed daily aspirin therapy by their doctors are instructed to “take it at night”. I’m afraid this advice may be dangerous. Taking aspirin on an empty stomach can eventually cause an ulcer—or a serious GI bleed leading to anemia, or worse.
Over 100,000 people per year are hospitalized due to GI bleeds caused by frequent NSAID use (non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen).
That’s why aspirin should ALWAYS be taken with or right after a meal. This includes baby aspirin too.
I see lots of people who take a daily aspirin not on their doctor’s advice, but because they think it’s a prudent thing to do for their health. Well, daily aspirin therapy for primary prevention (meaning for those with no established heart disease) is no longer recommended for those 70 and older, according to the most recent guidelines just released last week by the American College of Cardiology and the American Heart Association.
So please don’t self-prescribe a daily aspirin regimen without first talking to your healthcare practitioner who is trained to clarify for you the risks and benefits in the context of your overall health. And, as with most medications, long term use requires monitoring of liver and kidney function.
To your health!
Leyla Muedin, MS, RD, CDN
