From the Guidelines
Aspirin is not recommended as a primary treatment for high cholesterol, but it may be considered for patients with high cholesterol who are at increased cardiovascular risk, particularly those with a history of atherosclerotic cardiovascular disease or multiple risk factors 1. The primary goal in managing high cholesterol is to reduce the risk of cardiovascular events, such as heart attacks and strokes, through lifestyle modifications and medications that lower cholesterol levels.
- The medications typically used to treat high cholesterol include statins, ezetimibe, PCSK9 inhibitors, and bile acid sequestrants, which work by different mechanisms to lower cholesterol levels in the blood.
- Aspirin, on the other hand, is an antiplatelet medication that is primarily used to prevent blood clots and reduce the risk of heart attack and stroke in people with established cardiovascular disease or multiple risk factors, as it inhibits platelet aggregation but does not affect cholesterol levels 1. In certain cases, aspirin may be recommended alongside cholesterol-lowering medications for patients with high cholesterol who are at increased risk of cardiovascular events, such as those with a history of atherosclerotic cardiovascular disease, diabetes, hypertension, dyslipidemia, smoking, or albuminuria 1.
- The decision to use aspirin in these cases should be based on an individual assessment of the patient's cardiovascular risk and the potential benefits and risks of aspirin therapy, including the risk of gastrointestinal bleeding 1. It is essential for patients with high cholesterol to consult with their healthcare provider to determine the best course of treatment, which may include lifestyle changes, cholesterol-lowering medications, and possibly aspirin, depending on their overall cardiovascular risk profile 1.
From the Research
Aspirin Therapy for High Cholesterol
- Aspirin is not typically given for high cholesterol, but rather for its antiplatelet effects to reduce the risk of cardiovascular events 2, 3.
- The American Heart Association recommends that aspirin only be prescribed for "high-risk" individuals, and the decision to use aspirin therapy should be based on the pathophysiology of coronary artery thrombosis 2.
- Studies have shown that aspirin can reduce the risk of cardiovascular events in individuals with established cardiovascular disease, but its role in primary prevention is more controversial 4, 5.
- Recent trials have shown that aspirin may not be beneficial for primary prevention of cardiovascular disease in patients without overt cardiovascular disease, and may even cause harm due to an increased risk of bleeding 4, 5.
- However, individuals with elevated lipoprotein (a) levels may benefit from aspirin therapy for primary prevention to reduce the risk of atherosclerotic cardiovascular disease 6.
- The use of aspirin therapy should be individualized and based on the estimated ratio between the potential health benefits and harms, taking into account the patient's absolute cardiovascular risk and other factors 5.