There has been a lot of back and forth information over the years regarding the benefits and risks of low dose aspirin therapy in the prevention of cardiovascular events such as heart attack and stroke. As a result, many people are confused about what the recommendations are. Let’s look at the research to determine who might be benefited from this therapy, and who should avoid it.
It should be clarified that even though we commonly describe the 81 mg dosage as “baby aspirin”, aspirin at any dose should never be given to infants, as it increases the risk of a rare but potentially fatal condition called Reye’s Syndrome. Aspirin should be totally avoided before age three. Up to the age of 18 aspirin should not be given for the treatment of chicken pox, flu, or other viral upper respiratory illnesses. Now that these parameters have be set, let’s look at the recommendations for adults.
The most recent headlines have been mostly negative, recommending against otherwise healthy people taking 81 mg aspirin due to increased risk of bleeding. A 2019 study in JAMA looking at over 130,000 people showed a small but statistically significant increase in intracranial bleeding (bleeding inside the skull) in individuals on long term low dose aspirin therapy. These findings are in line with other similar large studies. For otherwise healthy individuals, it looks like the risks do outweigh the benefits. For individuals with a bleeding disorder, history of stomach ulcer, or GI bleeding, the therapy is especially contraindicated.
So when is low dose aspirin therapy a good idea? The research shows that it is usually a good fit for individuals between the ages of 50-70 who are at an increased risk of heart attack. This includes people who have had a previous heart attack or coronary bypass surgery. Significant family history of cardiovascular disease is another possible indication, though this should be determined on an individual basis. One other factor that is currently drawing more attention is having an elevated level of lipoprotein a (Lp(a)).
Lipoproteins are related to cholesterol and can be involved in the development of plaque formation within the vessel walls, known as atherosclerosis. Lp(a) is a particularly injurious lipoprotein particle, understood to cause a high degree of inflammation and vessel damage. Data also suggests that Lp(a) may be involved in progressive clot formation within previously damaged arteries, which occurs in heart attack and stroke. Indeed, the Copenhagen City Heart Study found that individuals with elevated plasma Lp(a) levels had 2-3 times elevated risk for a cardiovascular event, separate from all other risk factors. The other unfortunate thing about Lp(a) is that it is difficult to modify. Elevation is mostly hereditary, and standard cholesterol medications do not affect it. The diet and lifestyle change we promote for overall cardiovascular health also does little to bring it down. However, one of the therapies that is effective is aspirin. Low dose aspirin therapy is shown to modestly lower Lp(a), and perhaps just as importantly, it’s blood thinning effect reduces the cardiovascular risk that elevated Lp(a) carries.
The take home here is that it is always important to talk to your doctor about starting any new medication, and low dose aspirin is no exception. While some people fit squarely into the high or low cardiovascular risk categories, many individuals remain unclear as to whether aspirin is right for them. Testing Lp(a) is an effective way of better understanding overall cardiovascular risk, as well as determining whether low dose aspirin may be indicated. Lp(a) testing is an important component of a comprehensive cardiovascular assessment that is vital if you have personal or family history of heart disease. These assessments are available in our office and usually covered by health insurance. If your Lp(a) level is elevated, it is especially important to do everything you can to reduce the modifiable cardiovascular risk factors in your life. It is in your best interest for maintaining a healthy heart for years to come.