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Aspirin Therapy in Heart Disease

For over 100 years, aspirin has been used as a pain reliever. Since the 1970s, aspirin has also been used to prevent and manage heart disease.

How does aspirin benefit the heart?

  • Inhibits blood clots. Some of the prostaglandins in the blood trigger a series of events that cause blood platelets to clump together and form blood clots. Thus, when aspirin inhibits prostaglandins, it inhibits the formation of blood clots, as well. Blood clots are harmful because they can clog the arteries leading to the heart, increasing the risk of heart attack and stroke. Aspirin has been shown to reduce the risk of heart attack and reduce the short-term risk of death among people suffering from heart attacks.
  • Decreases pain. Aspirin fights pain and inflammation associated with heart disease by blocking the action of an enzyme called cyclooxygenase. When this enzyme is blocked, the body is less able to produce a substance called prostaglandin, which is a chemical that signals an injury and triggers pain.
  • Reduces the risk of death. Research has shown that regular aspirin use is associated with a marked reduction from death due to all causes, particularly among the elderly, people with heart disease, history of stroke, and those who have been diagnosed with colorectal cancer.

Additionally, aspirin may also reduce the risk of polyp recurrence in people with a history of colon polyps.

Who may benefit from aspirin therapy?

  • People with atherosclerosis, including those with coronary artery disease, stroke, or transient ischemic attack (TIA)
  • People who have had a heart attack or those who are experiencing symptoms of heart attack (* see note below)
  • People who have undergone bypass surgery to treat heart disease, or have angina (chest pain)
  • People with any risk factor for heart disease or a heart attack
  • Men over the age of 40 and possibly women over the age of 50
  • People who have had a transient ischemic attack (TIA) or ischemic stroke
  • People who have been diagnosed with colorectal cancer

What are the risks and benefits of aspirin therapy?

While aspirin has been linked to increased survival in certain patient populations, it is a medication that has risks as well.  Always ask your doctor before starting any medications - including aspirin.

Benefits
  • Aspirin can significantly reduce heart damage during a heart attack and can prevent the occurrence of future heart problems.
  • Aspirin can reduce the risk of stroke.
Risks
  • Aspirin can increase the risk of stomach ulcers and gastrointestinal bleeding.
  • During stroke, aspirin can increase the risk of bleeding into the brain.

How much aspirin should I take?

Always speak to your doctor about the benefits and risks of aspirin therapy before beginning a regular regimen.

Recent research indicates an appropriate dose of aspirin is between 80 and 160 mg per day. This is actually half of the standard 325-milligram aspirin commonly prescribed. Many studies show the lower dose works just as well as the higher dose, while reducing the risk of internal bleeding. A baby aspirin contains 81 mg. There are similarly lower-dose adult aspirin varieties available. But check with your doctor first to find out what dose is right for you.

How should I take aspirin?

  • Aspirin should not be taken on an empty stomach. Take aspirin with a full glass of water with meals or after meals to prevent stomach upset.
  • Do not break, crush, or chew extended-release tablets or capsules--swallow them whole. Chewable aspirin tablets may be chewed, crushed, or dissolved in a liquid.
  • Before this medication is prescribed, tell your doctor if you are allergic to aspirin, ibuprofen, or naproxen.
  • Aspirin should never be taken in place of other medications or treatments recommended by your doctor.
  • Do not drink alcoholic beverages while taking this medication. Taking aspirin with alcohol increases the chance of stomach bleeding.

While taking aspirin, ask your doctor what other medicines you may take for pain relief or minor colds. Read the labels of all pain relievers and cold products to make sure they are aspirin-free. Other medicines containing aspirin or nonsteroidal anti-inflammatory drugs may cause bleeding problems when taken in combination with your regular aspirin therapy.

Before any surgical or dental procedure or emergency treatment, tell the doctor or dentist that you are taking aspirin. You might need to stop taking this medicine for five to seven days before dental work or surgery. However, do not stop taking this medicine without first consulting with your doctor.

* If you are experiencing symptoms of a heart attack, first call 9-1-1. DO NOT DELAY CALLING 9-1-1.  After you call 9-1-1, if you do not have a history of aspirin allergy or bleeding, emergency personnel may advise that you chew one aspirin slowly. It's especially effective if taken within 30 minutes of the onset of symptoms.   Do NOT take an aspirin for symptoms of stroke.

Are there any side effects?

Yes, aspirin does have side effects. Some common side effects include nausea, upset stomach, nervousness, and trouble sleeping. Call your doctor if any of these symptoms become severe or do not go away.

If you have any of the following side effects, contact your doctor right away:

  • Severe stomach pain or heartburn
  • Severe nausea or vomiting.
  • Any signs of unusual bleeding, such as blood in the urine or stools, nosebleeds, any unusual bruising, heavy bleeding from cuts, black tarry stools, coughing up of blood, unusually heavy menstrual bleeding or unexpected vaginal bleeding, vomit that looks like coffee grounds
  • Signs of allergy including hives, facial swelling, rash
  • Asthma attack (also indicates an allergy)
  • Ringing in the ears
  • Severe headache pain
  • Confusion

Who should not take aspirin?

  • Children under the age of 18 who are recovering from a viral infection such as the flu or chicken pox
  • Pregnant women (unless otherwise directed by your doctor)
  • People who are about to undergo surgery
  • Heavy drinkers
  • People with ulcers or any bleeding problem 
  • People taking regular doses of other pain medications, such as Motrin
  • People who are allergic to aspirin

The final message: Talk to your doctor to see if you should take aspirin.

References:

Reviewed by Dr. Ben Barzilai -Section Head of Clinical Cardiology - Robert and Suzanne Tomsich Department of Cardiovascular Medicine in the Miller Family Heart and Vascular Institute.

Reviewed: 08/09

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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