What are the benefits of taking daily low-dose (baby) aspirin (acetylsalicylic acid) for cardiovascular health?

Benefits of Daily Low-Dose Aspirin for Cardiovascular Health

Low-dose aspirin therapy is not recommended for primary prevention of cardiovascular disease in adults 60 years or older, but may provide a small net benefit for adults aged 40-59 years with a 10-year cardiovascular risk of 10% or greater. 1, 2, 3

Primary Prevention Recommendations

Age-Based Recommendations

• Ages 40-59 years:

  • Consider aspirin only if 10-year ASCVD risk ≥10% AND no increased bleeding risk 1, 2
  • Decision should be individualized based on cardiovascular risk vs. bleeding risk assessment 1
  • Benefits are modest (12% reduction in vascular events) but must be weighed against increased bleeding risk (29% increase) 1

• Ages 60 years and older:

  • Not recommended for primary prevention due to bleeding risks outweighing cardiovascular benefits 1, 2

• Under 40 years:

  • Not recommended due to insufficient evidence of benefit 1
  • Contraindicated in individuals under 21 years due to risk of Reye syndrome 4, 1

Risk Assessment Factors

• Calculate 10-year cardiovascular risk using established risk calculators
• Consider additional factors that increase cardiovascular risk:
  • Family history of premature CVD
  • Hypertension
  • Dyslipidemia
  • Smoking
  • Albuminuria/chronic kidney disease 1

Secondary Prevention Benefits

For patients with established cardiovascular disease (prior heart attack, stroke, or peripheral arterial disease), the benefits of aspirin are much clearer:

• Strong recommendation for all patients with documented atherosclerotic cardiovascular disease 1, 5
• Provides significant reduction in recurrent cardiovascular events 1, 5
• Indicated for life-long therapy after:
  • Myocardial infarction
  • Stroke
  • Peripheral arterial disease
  • Coronary stent placement 1, 5

Optimal Dosing

• Recommended dose: 75-162 mg daily 4, 1
• 81 mg daily is the most common dose in the US and generally preferred 4, 1
• Higher doses (>100mg) increase bleeding risk without providing additional cardiovascular benefit 4, 1, 6
• The ADAPTABLE trial showed no significant differences in cardiovascular events or major bleeding between 81 mg and 325 mg daily doses 4

Bleeding Risk Considerations

When considering aspirin therapy, assess for bleeding risk factors:

• Age >70 years
• History of GI bleeding or peptic ulcer disease
• Concurrent use of anticoagulants or NSAIDs
• Uncontrolled hypertension
• Renal disease or anemia 1

For patients at higher risk of GI bleeding who require aspirin therapy, consider adding a proton pump inhibitor 1

Special Considerations

• Aspirin resistance: Occurs in 10-20% of patients taking aspirin, with higher rates reported in specific populations (up to 60-80% in stroke and post-MI patients) 5
• Diabetes: Diabetic patients may have altered platelet function, but this does not necessarily warrant higher aspirin doses 4, 1
• Weight considerations: Some evidence suggests reduced efficacy in those weighing >70 kg, but the ASCEND trial found benefit of low-dose aspirin in this weight range 4

Clinical Implications

The decision to use aspirin for primary prevention requires careful weighing of cardiovascular benefit against bleeding risk. The most recent guidelines have become more conservative about aspirin use for primary prevention as newer evidence has emerged showing that bleeding risks may offset cardiovascular benefits in many individuals.

Regular reassessment of cardiovascular and bleeding risk is necessary for patients on aspirin therapy 1.