Should Aspirin Be Prescribed Daily for Heart Health?

By | June 20, 2020

Heart disease can include several problems related to the heart and blood vessels, many of which are related to atherosclerosis. A buildup of plaque in the walls of the arteries makes it difficult for blood flow, which can lead to a heart attack or stroke. In 2017, 859,125 deaths in the U.S. were attributed to cardiovascular disease.1

According to the American Heart Association, the disease kills more people every year than all forms of cancer and chronic lower respiratory diseases combined. Coronary heart disease is the main problem, followed distantly by stroke, high blood pressure and heart failure.

The high rate of cardiovascular disease (CVD) in the U.S. contributes to an estimated financial burden that in 2017 topped $ 320 billion related to treatment and productivity.2 On the current trajectory, estimates are that the price tag will exceed $ 1 trillion by 2035.3

In addition to the health challenges from the disease itself, CVD increases your risks from COVID-19. Researchers have found that those with pre-existing heart disease, who subsequently are infected with COVID-19, have an increased risk of heart attack or congestive heart failure which may be related to the combination of viral illness and higher demands on the heart.4

Heart arrhythmias can develop, and severe heart muscle injury is strongly associated with an increased risk of death. Risk factors linked to cardiovascular disease include smoking, physical inactivity, overweight and obesity, diabetes and high blood pressure.5

Low-Dose Aspirin Raises Risk for Healthy People

In a study recently published in the British Journal of Clinical Pharmacology, researchers sought to identify outcomes associated with taking low-dose aspirin.6 Using data from 67 studies published by August 15, 2019, they performed a meta-analysis of observational and randomized controlled trials.7

The data were separated by type. In the observational studies, researchers found “highly suggestive evidence” that using aspirin could raise the risk of gastrointestinal bleeding.

In the randomized control trials, they found “strong evidence” that low-dose aspirin could lower the risk of CVD in healthy people, but it came with a high risk of bleeding in the gastrointestinal tract and brain.

After years of prescribing low-dose aspirin to reduce the risk of CVDs, the researchers felt there was a lack of evidence related to the balance between risk and benefit.8 They noted that low-dose aspirin in otherwise healthy people without CVD could lower the incidence of heart events by 17%.

The events included nonfatal heart attacks and strokes as well as deaths related to cardiovascular events. However, while taking low-dose aspirin slightly reduced the risk of cardiovascular events, it also raised the risk of gastrointestinal bleeding to 47% and intracranial bleeding to 34%.

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While the practice is no longer recommended by the Food and Drug Administration for those who’ve not had a cardiovascular event,9 results from a 2019 study revealed that people were taking aspirin without a physician’s recommendation.10

Of those surveyed, 44.6% of people from age 70 to 79 and 34.7% of those age 60 to 69 were taking aspirin as a primary means of preventing cardiovascular disease. They concluded:11

“… that low‐dose aspirin decreased the risk of CVD events in the general population (when compared to placebo/no intervention) with strong evidence according to GRADE criteria, whilst the data for individual CVD outcomes are limited.”

Not Recommended for Primary Prevention of Heart Disease

Following the results of several studies, the recommendation for daily aspirin was rescinded. One of the writers of the new guidelines, which were adopted and developed by the American Heart Association (AHA) and American College of Cardiology (ACC), said:12

“We’re talking about healthy people who don’t have known heart disease or stroke, who might have been considering or already taking an aspirin to prevent that heart attack or stroke in the first place.”

The new guidelines came five years after the FDA indicated that low-dose aspirin was not for everyone and should be used only on the advice of a clinician.13 In 2019 the guidelines were then changed by the AHA and ACC, highlighting the need for people to make healthy lifestyle changes to help reduce their risk of heart disease.14

The British study supports results from past research. In one study, published in JAMA Network in 2019,15 researchers were investigating whether there is an association between aspirin and bleeding events in those who do not have CVD.

They performed a meta-analysis of 13 trials involving people who did not have heart disease and found that the use of “aspirin was associated with a lower risk of cardiovascular events and an increased risk of major bleeding.”16

Importantly, the authors of other studies have found that prophylactic use of aspirin in people over the age of 70 can cause harm.17 Of course, older individuals may have higher potential risk for heart disease and therefore more likely to be prescribed aspirin therapy as a preventive measure.

The results of current studies and guidelines by the AHA point to avoiding daily aspirin for those with no history of heart disease, or those who have a low to moderate risk. As the AHA writes:18

“The new recommendation doesn’t apply to people who already have had a stroke or heart attack, or who have undergone bypass surgery or a procedure to insert a stent in their coronary arteries. These individuals already have cardiovascular disease and should continue to take low-dose aspirin daily, or as recommended by their health care provider, to prevent another occurrence.”

Is the Risk Profile Lower for People With Heart Disease?

Although the AHA and ACC recommend low-dose aspirin for people who have heart disease or have had a cardiovascular event, there is evidence suggesting it may not be the ideal solution for this population.

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For example, in a study published in 2004, scientists assessed the risks and benefits of aspirin and Warfarin in people who had heart failure.19 They found that the treatment group receiving aspirin had worse cardiac outcomes, including deteriorating heart failure. According to the authors in that study, their data showed “no evidence that aspirin is effective or safe in patients with heart failure.”20

In a 2010 study it was reported that older adults with heart disease and a history of using aspirin had an increased risk of having another heart attack, compared to those who had not been on aspirin therapy.21

In a 2009 meta-analysis, researchers looked at six studies and found no evidence that clearly supported aspirin as an effective strategy in preventing cardiovascular events in people with diabetes.22 The study’s authors go so far as to note that aspirin actually increases mortality in this group, based on the title of their paper.

A 2009 study was conducted to examine the effects of daily aspirin in patients with diabetes; the authors found it “significantly increased mortality in diabetic patients without cardiovascular disease from 17% … at age 50 years to 29% … at age 85 years.”23 The results also indicated that aspirin may also lower mortality in elderly diabetic individuals who do have CVD.

Reducing Your Iron Levels May Also Offer Protection

Addressing your serum iron levels also helps protect your heart health. Data show th at iron can build up in your body and that it’s linked to CVD.24 More specifically, it’s linked to atherosclerosis as it helps catalyze the development of reactive oxygen free radicals that contribute to the formation of arterial plaque.

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What many people, physicians included, fail to appreciate is that the body has no significant way of getting rid of excess iron. Women who are still menstruating will have blood loss each month, but other minor amounts lost through normal bodily processes are not enough to reduce overall excess iron in everyone else.25

Many supplements include iron, and it’s added to lots of processed foods. For instance, two servings of fortified breakfast cereal may provide you with as much as 44 mg,26 bringing you dangerously close to the upper tolerance limit of 45 mg for adults. This is well over the recommended daily allowance, which is 8 mg for men and 18 mg for premenopausal women.27

Iron overload is much more common than deficiency and is linked to several chronic conditions, including Alzheimer’s disease.28 One of the simplest ways to address this issue is by donating blood. You may not know you have too much iron unless you get tested.

Blood donation is also safe. Results from several studies have demonstrated improvements in chronic conditions with consistent blood donation, including reducing high blood pressure and improving glycemic control29 as well as reducing symptoms and severity of gout30 and heart disease.31

Nattokinase or Lumbrokinase Reduces Clot Formation

Another option to protect heart health is using nattokinase or lumbrokinase. Nattokinase is produced by Bacillus subtilis as it is fermenting soybeans to produce natto.32 The compound is a strong thrombolytic comparable to aspirin, but without the serious side effects.

It works by dissolving fibrin in the blood vessels, improving circulation and decreasing blood viscosity. These effects can also help reduce high blood pressure. In one study, participants experienced a decrease in systolic and diastolic blood pressure while taking nattokinase.33

Using aspirin and statin medications comes with a long list of serious side effects, but nattokinase has been used for centuries with few reported adverse events. A second option is lumbrokinase, which may be even better than nattokinase.

This is a fibrinolytic enzyme34 that’s extracted from earthworms and helps reduce blood viscosity. It also degrades fibrin, a key factor in clot formation.35 The substance is not well known by health experts, especially by Western health practitioners and consumers. The compound is effective for multiple purposes in overall health. Discover more in “Lumbrokinase for Heart Health?