Does taking aspirin daily help prevent heart disease?

According to data released by the Pan American Health Organization (PAHO), cardiovascular disease (CVD) is the leading cause of death in the world. In 2017 alone, the number of patients who suffered complications such as heart attacks and strokes was 17 million.

These alarming numbers are also reflected in the country. According to the Brazilian Society of Cardiology, in Brazil, cardiovascular diseases represent more than 30% of deaths registered in the country.

To reduce these estimates, prevention against these diseases is one of the most sought after and promoted ways by institutions such as the World Health Organization and the Ministry of Health.

At the heart of the discussion is the use of acetylsalicylic acid , known as aspirin or AAS.

Usually, the drug is used to treat symptoms of flu, colds, menstrual cramps, joint and muscle pain.

But as a preventive measure, the drug has also been used to fight heart disease.


What do the researchers say?

Science has already concluded that aspirin, in low daily doses, serves as an option for secondary prevention of CVD . That is, the substance can be used in patients who have already suffered cardiovascular complications, such as a stroke or heart attack.

In general, in patients with these conditions, the benefits of using aspirin are considered to outweigh the risks. However, they should only be done when there is medical advice, as self-medication can bring serious health risks.

But, in relation to primary prevention , that is, in people who have never had any cardiovascular disease , there are no studies that prove the benefit .

On the contrary, according to research published by Harvard Health Publishing, the use of aspirin in these cases can be even more dangerous for health, and can cause complications such as gastrointestinal and cerebral bleeding.

The ARRIVE study, presented at the European Society of Cardiology conference (one of the largest meetings on cardiology in the world), showed important results regarding the relationship between aspirin and the primary prevention of CVD.

The study was based on the evaluation of more than 19 thousand healthy people, mixing them between those who used 100 mg of aspirin daily and those who received placebo (a substance without therapeutic properties).

After 5 years of follow-up, the study did not show that the use of aspirin is beneficial in relation to the risks, as there was a significant increase in complications such as gastrointestinal bleeding. Regarding heart attacks, strokes and deaths, there was no significant change in rates.

Therefore, it is not right to say that aspirin can prevent heart complications in healthy people, who have never had a stroke, heart attack or other complications.

In studies prior to this and according to the  Food and Drugs Administration (FDA), in the USA, the conclusion is that the data are insufficient to confirm the benefits in the use of aspirin by healthy people.

Thus, it is recommended, for the time being, that people without a history of heart disease should not take aspirin daily as a prevention, as the risk-benefit ratio is still inconclusive.

What should be taken into account are medical guidelines and a change in habits to reduce risk factors.

How aspirin helps in the secondary prevention of cardiovascular disease

According to the pharmacist and doctor of pharmacology Francielle Tatiana Mathias, people who have already had an episode of cardiovascular problems, such as stroke or infarction , have a greater chance of a recurrence. Therefore, aspirin (AAS) can be used for prevention.

Aspirin is a medication that belongs to the class of AINES (non-steroidal anti-inflammatory drugs), made from the active ingredient acetylsalicylic acid.

It is a drug that works by inhibiting an enzyme called COX (cyclooxygenase), responsible for converting the molecule arachidonic acid into prostaglandins, mediators present in inflammatory processes such as fever and pain. Therefore, by inhibiting the action of COX, aspirin helps in the treatment of inflammatory processes.

However, COX also converts arachidonic acid into thromboxanes, which are the mediators responsible for causing vasoconstriction and plaque formation (platelet aggregation).

“In these people, AAS is a good strategy, as it differs from other NSAIDs in that it causes an irreversible COX inhibition, since for other NSAIDs the inhibition is reversible”, he explains.

In this sense, aspirin can contribute to the secondary prevention of CVD by preventing this conversion of arachidonic acid into thromboxanes and preventing the formation of clots, one of the risk factors for diseases such as heart attacks, stroke and other cardiovascular complications.

As a primary prevention in healthy people or those who do not have risk factors, the use is not indicated precisely because it is not necessary to prevent blood clots.

“People who do not have any type of cardiovascular dysfunction should not have their clotting process altered, this will only predispose to unnecessary bleeding”, warns the pharmacist.

After all, should I take aspirin every day?

In general, the answer is no . The use of medications, whether for punctual or continuous use, should not be done without medical advice.

As the study presents, the daily use of aspirin should only happen when the patient’s doctor, who must previously know his history and assess the risk-benefit ratio, understands that it is necessary, as there are healthy patients who are at a higher risk of developing cardiovascular disease and so they can benefit.

But that includes people with a family history of premature heart attacks, very high cholesterol, who are smokers and other risk factors, for example. However, use should not be made at the patient’s initiative .

In healthy people who do not have any risk factors associated with the development of CVD, it is best to opt for other prevention alternatives, as aspirin can cause serious side effects, such as bleeding.

How to prevent cardiovascular diseases?

Some risk factors, such as genetics, age and sex, are considered irreversible and are beyond the patient’s control. However, it is possible to prevent cardiovascular diseases by controlling risk factors related to habits.

The main risk factors involve high levels of cholesterol and triglycerides, diabetes , obesity , hypertension and physical inactivity, for example.

To help keep your heart healthy it is important to exercise, eat better, keep cholesterol levels under control, reduce sugar consumption, control weight, be careful with blood pressure, stop smoking and reduce stress .

People with a family history, especially, should follow these precautions and undergo regular medical monitoring.

To reduce death rates from cardiovascular disease, something needs to be done. However, according to the present studies, using drugs such as aspirin for primary prevention is still not the best path to be followed, nor the safest.

So, choose a healthier lifestyle and maintain a preventive routine of visits to the doctor. Share this story so that more people know how to take better care of the heart!

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