Aspirin for primary prevention

Hope you all are doing well.  This post is about those people who take aspirin for primary prevention – i.e. those of you who have not had a heart attack before.  I am wondering how many of you do it or are considering doing so?

I get this question occasionally.  Most of my patients already have heart trouble (hence, they see me) and the benefits of aspirin are very well established once you’ve had coronary disease – approximately a 20% reduction in further heart attacks.  The advantage of aspirin in primary prevention, those without established heart disease, is less impressive.  However there still certainly is evidence to support it!  The Physician’s Health Study and other trials do show that aspirin can be beneficial in certain people.  The most recent guidelines say to individualize your recommendation based on the patient’s cardiovascular disease risk and risk of bleeding.  The risk of bleeding is low with aspirin, about 1% per year beyond what your risk is without it.  My usual practice is to recommend aspirin for those people over age 40, both men and women, with intermediate to high risk of coronary disease (10 year risk of a heart attack greater than 10%).  To calculate risk I use either Framingham or Reynolds risk scores, both of which are available online.

People ask me all the time about herbal supplements and things for the same purpose.  My answer is always the same: there is no data to support their use and take them at your own risk.  Yes, aspirin is a pharmaceutical.  We know what is in it and I can print the trials and show you the drug works, as well as quote you the side effects.  There is no such data for these supplements, usually only anecdotal experience from a few patients or the testimony of some pseudo-MD who has a “wellness clinic” or is on late night TV.

I am wondering if you have any thoughts on this – do you use it yourself?  Considering it?  Considering supplements/herbals?  From my tone you may think I hate alternative medicine – this is not the case.  I just do not recommend it, because people come to me looking for recommendations based on scientific trials and proof.  If one of these alternative products is submitted to a proper randomized controlled trial I would be happy to review it.