Should You Take Aspirin to Prevent a Heart Attack?

With more a third of Americans now taking low-dose aspirin to reduce their risk of heart attack it's important to understand when aspirin should be taken and what the health risks are.

How aspirin can help prevent heart attack

When bleeding occurs, cells called platelets form around the site of the wound, sealing the wound and stopping the bleeding. If the clots form in the blood vessels around the inner arteries that carry blood to the heart, it can prevent blood flow, leading to a heart attack. Aspirin interferes with the blood's clotting action, reducing the formation of platelets where bleeding is occurring.

Should you be taking a daily aspirin to prevent a heart attack or stroke?

In 2019, the American Heart Association and American College of Cardiology released a study noting the lack of benefits for most people without known heart disease, and the potential risks of taking a daily aspirin to reduce the risk of a heart attack.

No one should begin taking aspirin at any dose without first consulting with a physician to determine their risk of cardiovascular disease. Simply having a family history of heart disease and stroke is not enough to make an informed decision and may put you at risk from complications. The potential complication from taking even a baby aspirin include cerebral hemorrhage and gastrointestinal bleeding.

A recent study published in the Journal of the American College of Cardiology found that more than 1 in 10 patients in the U.S. were inappropriately prescribed aspirin for primary prevention of cardiovascular disease. Inappropriate use of aspiring was defined by primary cardio vascular disease prevention guidelines as use of aspirin therapy in patients with a 10-year cardiovascular disease risk of less than 6 percent.

The best way to predict whether you are at risk is to have a noninvasive CT scan of your heart to look for coronary calcium. This is considered by most experts to be the most reliable predictor of a future heart attack. The result of this scan is called a calcium score, and it reflects the amount of atherosclerotic plaque that you’ve built up in your coronary arteries over a lifetime. The higher your calcium score, the more plaque in your arteries and the greater your risk of a future heart attack or stroke.

The bottom line is that aspirin is not a magic bullet, and carries significant risk, but under certain circumstances, including preventing a second stroke or heart attack, the benefits can outweigh the risks.