I spoke with a patient (Andy) who said he took aspirin. Since I already knew his health history, I asked why he was taking this popular drug. Andy told me he thought it was a good preventative choice for heart disease. I replied that the recommendations for taking aspirin regarding cardiovascular protection had changed a few years ago and that he should NOT be taking aspirin. I told Andy that in his case, the risks of bleeding in the digestive tract and other side effects were too high relative to potential benefits. Andy was thankful for updating me that he was not a good candidate for aspirin therapy.

‍Who Should Take Aspirin?

‍Aspirin has a long history of use as a blood thinner to reduce blood clots and prevent heart attacks and stroke.  The use of aspirin used to be a general recommendation for adults as a preventative pharmaceutical for cardiovascular protection. However, this recommendation is outdated and should no longer be followed. For people without heart disease, it is no longer a general recommendation. The updated guidance on aspirin use comes from the U.S. Preventive Service Task Force (USPSTF). Aspirin is generally recommended for secondary prevention for people with atherosclerotic cardiovascular disease (ASCVD) (plaque in the blood vessels) or those with existing cardiovascular problems or a history of cardiovascular disease.

‍General Guidelines

• Aspirin (75-100 mg) is a consideration for the primary prevention of ASCVD for select adults 40 to 70 years of age who are at higher risk of ASCVD but not at increased bleeding risk.
• Aspirin (75-100 mg) should NOT be recommended on a routine basis for the primary prevention of ASCVD for adults >70 years of age.
• Aspirin (75-100 mg) should not be recommended as primary prevention of ASCVD for adults of any age who are at increased risk of bleeding.

Coated vs. Non-coated Aspirin

‍Erosion and bleeding of the digestive system is a concern with aspirin use. Therefore, enteric-coated aspirin is often recommended to reduce the likelihood of stomach erosion, ulcers, and bleeding, as the outer coating minimizes the breakdown of aspirin until it reaches the small intestine. However, Mayo Clinic authors report no difference in bleeding and ulcers with the enteric-coated vs regular aspirin. In addition, a recent study published in JAMA Cardiology involving over 10,000 participants found no significant difference in bleeding for those taking enteric-coated or regular aspirin.

‍Common Side Effects of Aspirin

• upset stomach
• heartburn
• drowsiness
• mild headache

Serious Potential Side Effects

• ringing in your ears, confusion, hallucinations, rapid breathing, seizure (convulsions)
• severe nausea, vomiting, or stomach pain
• bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds

Beware of Brain Bleeds

‍One of the potential side effects that most doctors do not warn their patients about with aspirin is bleeding of the brain. Studies have repeatedly demonstrated that low-dose aspirin (75-100 mg) significantly increases the risk of brain bleeds. For example, a 2023 study involving more than 19,000 older adults found a 38% increase in brain bleeds (intracranial bleeding). The authors stated that these findings suggest that low-dose aspirin should be reconsidered for primary stroke prevention and caution for using aspirin with older persons.

‍Leaky Gut Culprit

‍Aspirin is a known cause of leaky gut syndrome, where there is damage to the lining of the small intestine, resulting in malabsorption and inflammation. For patients where aspirin is indicated, I recommend supplementing our Gut Wellness to promote intestinal healing.

‍Conclusion

‍Speak with your doctor before stopping any medication, such as aspirin. If you have a cardiovascular condition that warrants aspirin, the benefits outweigh the risks. If you are taking aspirin and have no cardiovascular condition that justifies its use, speak to your doctor about stopping it. For nutritional approaches to preventing cardiovascular disease, see my many articles and videos on the Mediterranean Diet, which has been shown in numerous studies to reduce the risk of heart attack and stroke significantly.

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Dr. Mark Stengler NMD, MS, is a bestselling author in private practice in Encinitas, California, at the Stengler Center for Integrative Medicine. His newsletter, Dr. Stengler’s Health Breakthroughs, is available at  www.markstengler.com and his product line at www.drstengler.com

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References

American College of Cardiology. (2022, April 27). New USPSTF recommendation on aspirin in CVD: No for primary prevention, yes for secondary prevention. New USPSTF Recommendation on Aspirin in CVD: No For Primary Prevention, Yes For Secondary Prevention. https://www.acc.org/Latest-in-Cardiology/Articles/2022/04/27/20/41/New-USPSTF-Recommendation-on-Aspirin-in-CVD 

Cloud, G. C., Williamson, J. D., Thao, L. T., Tran, C., Eaton, C. B., Wolfe, R., Nelson, M. R., Reid, C. M., Newman, A. B., Lockery, J., Fitzgerald, S. M., Murray, A. M., Shah, R. C., Woods, R. L., Donnan, G. A., & McNeil, J. J. (2023). Low-dose aspirin and the risk of stroke and intracerebral bleeding in healthy older people. JAMA Network Open, 6(7). https://doi.org/10.1001/jamanetworkopen.2023.25803 

Sinha, S. Aspirin uses, dosage, side effects & interactions. Aspirin. https://www.drugs.com/aspirin.html 

Sleem A, Effron MB, Stebbins A, et al. Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease: A Secondary Analysis of the ADAPTABLE Randomized Clinical Trial. JAMA Cardiol. Published online October 04, 2023. doi:10.1001/jamacardio.2023.3364

Torborg, L. (2018, December 6). Mayo Clinic Q and a: Coated aspirin may not be as effective at reducing blood clot risk - Mayo Clinic News Network. Mayo Clinic Q and A: Coated aspirin may not be as effective at reducing blood clot risk. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-coated-aspirin-may-not-be-as-effective-at-reducing-blood-clot-risk/ 

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