Aspirin is not for everyone: ‘One-size-fits-all’ advice doesn’t work for heart disease

GALWAY, Ireland — Imagine you’re reaching for that bottle of aspirin in your medicine cabinet, a routine you’ve followed daily to keep heart troubles at bay. This time, however, a nagging question pops up: Is this little pill really shielding you from heart disease and stroke, or could it be unnecessary and perhaps even risky? A new study is shedding light on this very question, and it’s challenging long-held beliefs about the “one-size-fits-all” nature of aspirin guidelines.

At the heart of this investigation is a global study that delves into the effects of aspirin on preventing first-time heart attacks or strokes — a practice known as primary prevention. With over 47,000 participants from countries including the U.S., the U.K., and Australia, the study scrutinizes data from three clinical trials to unearth some surprising findings.

The crux of the problem addressed by the researchers is whether the international guidelines on aspirin use are valid for everyone. Traditionally, aspirin has been touted for its ability to prevent atherosclerotic cardiovascular disease — a condition that develops when a sticky substance called plaque builds up inside your arteries. However, these new insights suggest a more nuanced picture, particularly for those already taking aspirin before the trials began.

Patients who stopped taking aspirin experienced a higher risk of heart disease or stroke (12.5%) compared to those who continued its use (10.4%). Yet, there was no significant difference in major bleeding risks between the two groups. These numbers suggest that aspirin may still have a protective role for some, challenging the shift away from its routine use for primary prevention.

A new study is challenging long-held beliefs about the “one-size-fits-all” nature of aspirin guidelines. (© blueskies9 –

The research, led by Professor J. William McEvoy from the University of Galway, involved a careful analysis of patients at increased risk for cardiovascular disease. McEvoy notes that the study shows not all patients are the same, and a one-size-fits-all approach to discontinuing aspirin may not be appropriate.

In broader terms, this study sits at the intersection of evolving guidelines and ongoing efforts to tailor heart disease treatment more precisely. Aspirin, once a cornerstone of cardiovascular prevention, has seen its role questioned due to concerns over bleeding risks. Yet, for individuals without a history of bleeding and already taking aspirin, the benefits might outweigh the risks.

Let’s go back to our hypothetical aspirin user, pondering whether to continue using the over-the-counter drug. This scenario underscores a vital takeaway from the research: personal medical history and risk factors are crucial in making such decisions. While the study’s results are hypothesis-generating rather than conclusive, they offer a beacon for patients and doctors navigating the complex terrain of cardiovascular prevention.

“Our findings of the benefit of aspirin in reducing heart disease or stroke without an excess risk of bleeding in some patients could be due to the fact that adults already taking aspirin without a prior bleeding problem are inherently lower risk for a future bleeding problem from the medication. Therefore, they seem to get more of the benefits of aspirin with less of the risks,” Prof. McEvoy says in a university release.

“These results are hypothesis-generating, but at present are the best available data. Until further evidence becomes available, it seems reasonable that persons already safely treated with low-dose aspirin for primary prevention may continue to do so, unless new risk factors for aspirin-related bleeding develop.”

In essence, the journey of understanding aspirin’s role in heart health continues, with each study adding pieces to a larger puzzle. For the public, the message is clear: decisions about aspirin use should not be made in isolation but as part of a comprehensive discussion with healthcare providers, taking into account individual risks and benefits. As research evolves, so will our strategies for keeping our hearts healthy and strong.

The study is published in the journal Circulation.

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About the Author

Alexander Olumese, PharmD

Alexander Olumese is a DMV-based registered pharmacist and medical writer. He has over 10 years of experience with community and hospital pharmacies, as well as over 3 years within the pharmaceutical industry as a medical writer within medical affairs. He has a background in a variety of therapeutic areas. However, he specializes in cardiovascular disease, oncology, pain medicine, and infectious disease.

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