Aspirin, CVD Risk, & Potential Counter-Risks

Aspirin Pros & Cons

In Tuesday’s newsletter, we asked your health-related opinion of aspirin, and got the above-depicted, below-described set of responses:

• About 42% said “Most people can benefit from low-dose daily use to lower CVD risk”
• About 31% said “It’s safe for occasional use as a mild analgesic, but that’s all”
• About 28% said “We should avoid aspirin; it can cause liver and/or kidney damage”

So, what does the science say?

Most people can benefit from low-dose daily aspirin use to lower the risk of cardiovascular disease: True or False?

True or False depending on what we mean by “benefit from”. You see, it works by inhibiting platelet function, which means it simultaneously:

• decreases the risk of atherothrombosis
• increases the risk of bleeding, especially in the gastrointestinal tract

When it comes to balancing these things and deciding whether the benefit merits the risk, you might be asking yourself: “which am I most likely to die from?” and the answer is: neither

While aspirin is associated with a significant improvement in cardiovascular disease outcomes in total, it is not significantly associated with reductions in cardiovascular disease mortality or all-cause mortality.

In other words: speaking in statistical generalizations of course, it may improve your recovery from minor cardiac events but is unlikely to help against fatal ones

The current prevailing professional (amongst cardiologists) consensus is that it may be recommended for secondary prevention of ASCVD (i.e. if you have a history of CVD), but not for primary prevention (i.e. if you have no history of CVD). Note: this means personal history, not family history.

In the words of the Journal of the American College of Cardiology:

❝Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk (S4.6-1–S4.6-8).

Low-dose aspirin (75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age (S4.6-9).

Low-dose aspirin (75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding (S4.6-10).❞

~ Dr. Donna Arnett et al. (those section references are where you can find this information in the document)

Read in full: Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology

Or if you’d prefer a more pop-science presentation:

Many older adults still use aspirin for CVD prevention, contrary to clinical guidance

Aspirin can cause liver and/or kidney damage: True or False?

True, but that doesn’t mean we must necessarily abstain, so much as exercise caution.

Aspirin is (at recommended doses) not usually hepatotoxic (toxic to the liver), but there is a strong association between aspirin use in children and the development of Reye’s syndrome, a disease involving encephalopathy and a fatty liver. For this reason, most places have an official recommendation that aspirin not be used by children (cut-off age varies from place to place, for example 12 in the US and 16 in the UK, but the key idea is: it’s potentially dangerous for those who are not fully grown).

Aspirin is well-established as nephrotoxic (toxic to the kidneys), however, the toxicity is sufficiently low that this is not expected to be a problem to otherwise healthy adults taking it at no more than the recommended dose.

For numbers, symptoms, and treatment, see this very clear and helpful resource:

An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose

Take care!