Take aspirin?

Christine, 62 years old “ I have a well-controlled hypertension and hypothyroidism, no heart disease or diabetes. My father died from a heart attack in his 80s”. 

Should I take aspirin to prevent heart disease? 

Dear Christine, This decision should be based on two factors: 

1. Your ASCVD risk. The American College of Cardiology (ACC)/American Heart Association(AHA) suggests using Arteriosclerotic Cardiovascular Disease (ASCVD) Risk Estimator to determine each individual's cardiovascular risk

2. Your Bleeding risk that depends from age, bleeding history, other health issues such as anemia, cancer, high blood pressure, diabetes, peptic ulcer disease, renal diseases, anemia, alcoholism, and previous stroke. The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease suggests (1):

-If your risk, estimated by the ASCVD estimator, is < 10%, I would not recommend taking aspirin because the risk of bleeding at your age overweighs the benefits.

-If your ASCVD risk is > 10%, low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) among adults 40 to 70 years of age who are not at increased bleeding risk. Even more, aspirin can be harmful if given on a routine basis for the primary prevention of ASCVD to adults older than 70 years old or of any age who are at increased risk of bleeding. 

The decision to initiate low-dose aspirin use for the primary prevention of CVD also depends on your risk factors for colon cancer, your life expectancy and your commitment to take aspirin for at least ten years. Therefore, do not make this decision alone , check with your PCP.You can find the most reliable recommendation at the U.S. Preventative Services Task Force 

1 Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., ... Ziaeian, B. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology, 74(10), e177–e232. https://doi.org/10.1016/j.jacc.2019.03.010

2 Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., ... Ziaeian, B. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology, 74(10), e177–e232. https://doi.org/10.1016/j.jacc.2019.03.010 

3 Dehmer, S. P., Maciosek, M. V., Flottemesch, T. J., LaFrance, A. B., & Whitlock, E. P. (2016). Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 164(12), 777. https://doi.org/10.7326/M15-2129