Primary prevention for stroke and heart attack. Find out if aspirin is right for you.
For some seniors, there’s little room left in the medicine organizer on the counter. You might already have several pills and supplements to help keep you active and well. So, before adding another pill to the pill box, you want to make sure it’s worth the effort and cost. Consider the risks and benefits of aspirin therapy for the primary prevention of stroke and heart attack.
Preventing stroke and heart attack is important for seniors, especially for those who have these risk factors for cardiovascular disease:
- High cholesterol
- High blood pressure
If you have one or more risk factors, your doctor may advise that you take low-dose aspirin (81 mg.) daily to lower the risk of blood clots that can cause heart attack or stroke.
Aspirin helps prevent clots from forming. Clots are what cause most strokes and heart attacks. If you don’t have strong cardiovascular risk factors, other than your age, or you have certain health problems that put you at increased risk for bleeding, the overall benefits of taking aspirin to prevent a first stroke or heart attack may not be clear cut.
Treatment to prevent a first stroke or heart attack is called primary prevention.
In the primary prevention of stroke or heart attack, there may be a delicate balance between benefits and risks of any treatment. Aspirin therapy has risks, including serious bleeding in the stomach or brain. This leads to a different type of stroke called a hemorrhagic stroke.
When making the decision whether to use daily aspirin therapy, you and your doctor will assess your risk factors for stroke and heart attack and weigh them against the chances you could have bleeding problems. Daily low-dose aspirin (81 mg.) helps men and women differently.
- In women, it cuts the risk of a first stroke.
- In men, it lowers the risk of a first heart attack.
To get started, talk to your doctor to define your cardiovascular risk factors and determine your risk for cardiovascular problems like heart attack and stroke.
After reviewing your risk factors for stroke or heart attack, your doctor can advise you on whether aspirin therapy is right for you. When the benefits outweigh the risks, daily aspirin therapy is recommended for:
- Men age 45 to 79 to reduce the risk of heart attack
- Women age 55 to 79 to reduce the risk of stroke
But if you are over 80, there is not enough evidence for or against aspirin therapy. You and your doctor will need to carefully weigh the decision to continue or start daily aspirin. It is based on many factors, such as your overall health, whether you drink alcohol and what other medications you are taking. For example, if you have liver or kidney problems, stomach ulcers or bleeding disorders, aspirin therapy may not be safe for you.
Note: If you’ve already had a stroke or heart attack, preventing another is called secondary prevention. This approach is well studied. Most people who have had either a stroke or heart attack are under aggressive treatment to prevent further heart attacks or strokes. In this group, the benefits of treatment to prevent a stroke or heart attack generally outweigh any of the risks of treatments.
A special case for prevention: atrial fibrillation and stroke
Atrial fibrillation (AF) is a heart rhythm disorder. It causes an irregular heartbeat. AF can raise the risk for blood clots in the heart that can break loose and lodge in the brain, causing a stroke. People with AF are about five times more likely to have a stroke than people who don’t have it. For this reason, people with AF may need more powerful anticlotting medications, such as:
- Anticoagulants (such as warfarin)
- Antiplatelets (such as clopidogrel sometimes added to aspirin)
But with the added “firepower” of these clot-preventing medications comes greater risk for bleeding. For most people with AF, though, the risk of stroke is higher than the risks of bleeding. People who take anticoagulants need to have their blood checked regularly and need to report any signs of bleeding to their doctor right away. (Comment: People who take antiplatelet agents also need to report any signs of bleeding right away!)