Low dose daily aspirin (70-100 mg once a day) is strongly recommended for patients who have had a heart attack or a stroke, together with patients who have symptoms of heart disease. [see references 1-3 ] In every hundred patients with heart disease who take aspirin, twenty or thirty heart attacks are likely to be prevented by aspirin in the next few years [4].

It is also difficult to summarise the value of aspirin in healthy people. Healthy people have a very low risk of a heart attack and so the actual number of attacks prevented by aspirin is likely to be small. This means that the number of heart attacks prevented by aspirin may be close to the number of stomach bleeds caused by the aspirin [4].

A bleeds from aspirin is a crisis, but on the other hand, while a heart attack can be fatal, the stomach bleeds caused by aspirin are very much less serious and there is no valid evidence that bleeds caused by aspirin are ever fatal…. so do read the section on aspirin and bleeding!

Healthy people have a low risk of a heart attack, so the number of attacks which is likely to be prevented by aspirin is very low. One estimate is that about 100 healthy people would have to take 70-100 mg aspirin daily for a year in order for one heart attack to be prevented [5], and at the same time another person in that hundred might have a stomach bleed [6].

Remember however that aspirin also reduces the risk of cancer, and if the risks of both heart disease and cancer are considered together, then aspirin taking by healthy older people is undoubtedly beneficial [see references 7-10]

Across the community, the number of heart attacks is declining steadily. There are also a number of new drugs which will reduce the risk of a heart attack, perhaps the most widely used of which are statins. Statins and aspirin work by quite different mechanisms within the body and there is no reason why they cannot be taken together – and remember, aspirin will also give protection against cancer.

People with diabetes have a greater than average risk of a heart attack, and the value of aspirin in these people is not well established. Recent research has however shown that the effect of an aspirin tablet wears off rather rapidly in some people with diabetes, and it has been suggested that effective protection may be achieved if 70-100 mg aspirin is taken twice daily, rather than the more usual once a day.[11 and 12]
In one of the largest overviews of trials of aspirin the authors pointed out that if a healthy person defers a decision about prevention of a vascular event by aspirin until he/she has some evidence of arterial disease, ‘…the first manifestations of disease might be a disabling of fatal event’.[4]

Aspirin is preventive and while the treatment of disease has been delegated to healthcare professionals, the preservation of health and the prevention of disease are the responsibility of each individual person. The most effective preventive of heart disease and other serious diseases, is a healthy lifestyle…. and this is ultimately the responsibility of each individual person. [See reference 13 and do read the website: Healthylivingwales.co.uk]

Probably no drug has been as thoroughly evaluated as aspirin in the prevention of heart disease! It has been estimated that over 140 randomised trials of aspirin, and numerous overviews of trials have been published! Yet, because of the present decline in the risk of heart disease throughout the community, the greatest value of aspirin may lie in its effect on the risk of cancer.

Aspirin was first made from a salicylate, a group of salts found widely in plants. Botanists tell us that salicylates have such a wide range of functions within plants, that much may yet be discovered about other benefits of aspirin to humans!

FINALLY -a warning, and a suggestion…..

If you do take aspirin regularly, do not suddenly stop taking it. Research has shown that if regular aspirin is suddenly stopped, the risk of a heart attack is increased about three-fold (see references 14 and 15).

and a suggestion… If a heart attack does occur, the sooner aspirin is taken the better. This is why Ambulance men and Paramedics usually give aspirin to a patient for whom an ambulance has been called because of sudden severe chest pain. It has therefore been suggested that older people should always carry an aspirin tablet (see references 16 and 17). A clever little container has been produced for carrying two tablets of aspirin.
Do google ‘ASPOD’ to see this.


  1. Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2012;33:1635-701.
  2. Aspirin for the prevention of cardiovascular disease: US Preventive Services Task Force recommendation statement. Ann Intern med 2009;150:396-404.
  3. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Atherosclerosis 2012;223:1-68.
  4. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. Brit Med J 2002;324:71-86.
  5. Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomised trials. Heart 2001;85:265-71.
  6. ** The role of aspirin in cancer prevention. Nat Rev. Clin. Oncol. 2012;9(5):259-267.
  7. Effect of including cancer mortality on the cost-effectiveness of aspirin for primary prevention in men. J Gen Intern Med May 2013 (epub ahead of print)
  8. The recovery of platelet cyclooxygenase activity explains interindividual variablility in responsiveness to low-dose aspirin in patients with and without diabetes. J Thromb Haemostasis 2012;10:1220-30.
  9. Primary and secondary prevention of cardiovascular disease in diabetes with aspirin. Diabetes & Vasc Dis Res. 2012;9:245-55.

By NOSCO Management Solutions Ltd www.nosco-systems.com (01443 400998)

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