Is this decision for you? This could be a decision for you if you have NOT had a heart attack or a stroke and you and your doctor are deciding whether aspirin might help you. Aspirin is strongly recommended for people who have been diagnosed with coronary heart disease or who have had a heart attack or some kinds of stroke. Aspirin may also be used by people who've had bypass surgery or angioplasty or who have peripheral artery disease.
A heart attack most often happens because blood flow through one or more of the coronary arteries is blocked. This blockage is usually caused by a blood clot that forms when plaque in the artery breaks open. A stroke occurs when a blood clot blocks a blood vessel in the brain (ischemic stroke). Aspirin can prevent blood clots from forming in your arteries. This may help prevent a heart attack or stroke.
People who have certain health problems shouldn't take aspirin. These include people who:
Aspirin causes your blood to clot more slowly. This increases your chance of bleeding problems, which can be serious.
Aspirin can cause:
Most doctors think that a heart attack or stroke usually causes more damage than a serious bleed.
The risk of bleeding isn't the same for everyone. For example, people's risk of bleeding gets higher as they get older. Your doctor can help you know your risk of bleeding based on your age and your health.
Some people have other problems from aspirin. These include an allergic reaction, stomach pain, and nausea.
Your doctor can help you understand your risk of heart attack or stroke and your risk of bleeding. Then you can decide what's right for you.
You and your doctor may also talk about your age. People who are younger than 40 don't seem to benefit much from aspirin. For people older than 60 or 70, the risk of bleeding is likely greater than the possible benefit of taking aspirin.1, 2 Your doctor can help you understand whether aspirin might help you based on your age.
Your doctor can estimate your risk for a heart attack or stroke in the next 10 years. Your doctor may use a tool called a risk calculator to figure out your risk. The tools are not perfect. They may show that your risk is higher or lower than it really is. But they can give you and your doctor a good idea about your risk.
There are different calculators, but they all include details about your health. These include:
You can do other things to reduce your chance of having a heart attack or stroke. These things are important whether you take a daily aspirin or not.
Evidence shows that for people with a high risk of heart attack or stroke, aspirin lowers the chance of heart attack, stroke, and dying from heart disease. The quality of this evidence is high.
Take a group of 100 people who have a high risk of heart attack or stroke. Here are their chances of having one in the next 10 years:5, 3
Note that:
Number of people who have serious bleeding problems within 10 years | ||
---|---|---|
Risk of serious bleeding | Without aspirin | With aspirin |
Low risk | 1 out of 100 | 2 out of 100 |
Moderate risk | 10 out of 100 | 15 out of 100 |
High risk | 20 out of 100 | 30 out of 100 |
*These numbers are examples based on research studies.5, 3
Evidence shows that aspirin increases the chance of serious bleeding. The quality of this evidence is high.
Take a group of 100 people who have a low risk of bleeding. Here are their chances of having serious bleeding in the next 10 years:5, 3
Take a group of 100 people who have a moderate risk of bleeding. Here are their chances of having serious bleeding in the next 10 years:5, 3
Take a group of 100 people who have a high risk of bleeding. Here are their chances of having serious bleeding in the next 10 years:5, 3
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.5, 3
The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.
Start taking daily aspirin | Don't start taking daily aspirin | |
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What is usually involved?
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What are the benefits?
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What are the risks and side effects?
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Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I've got high blood pressure, and I'm overweight. My doctor put all my information into a risk calculator. She said my risk of heart attack or stroke is high and my risk of bleeding is low, so she thought it would be a good idea if I took a baby aspirin every day. It's an easy thing I can do for my health. But I'm also trying to eat better, lose some weight, and be more active."
— Paul, age 55
"I've got diabetes, and that increases my risk of a heart attack or stroke. My doctor helped me compare my heart attack and stroke risk with my risk of bleeding. I'm not comfortable with the bleeding risk. I'm going to focus on managing my diabetes and skip the aspirin."
— Graciela, age 61
"I'm taking medicine for high cholesterol and high blood pressure. I wondered if I should be taking aspirin too, but my doctor said it could increase the risk of bleeding. I had a stomach ulcer, so aspirin would not be a good choice for me. I'll just keep taking my cholesterol and blood pressure medicines and work on improving my diet and exercise habits."
— Cal, age 58
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take daily aspirin
Reasons not to take daily aspirin
I'm willing to take pills every day to help prevent a heart attack or stroke.
I don't like taking pills.
I am more worried about having a heart attack or stroke than the risk of serious bleeding.
I am more worried about serious bleeding than my risk of a heart attack or stroke.
I want to do everything I can to lower my chance of having a heart attack or stroke.
I think I'm doing enough to lower my chance of having a heart attack or stroke.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Starting daily aspirin
NOT starting daily aspirin
1. Daily aspirin is helpful for most people.
2. If I have certain health problems, I may not be able to take aspirin.
3. I don't have to worry about any side effects from taking aspirin every day.
4. If I take a daily aspirin, it's not as important for me to follow a heart-healthy lifestyle.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
Current as of: June 24, 2023
Author: Healthwise Staff (https://www.healthwise.org/specialpages/legal/abouthw/en)
Clinical Review Board (https://www.healthwise.org/specialpages/legal/abouthw/en)
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.