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Should you take aspirin to prevent heart attack?

AHA Recommendation

You should not take daily low-dose aspirin without talking to your primary health care professional. The risks and benefits vary for each person.

If you have had a heart attack or , your health care professional might prescribe a daily low-dose aspirin to help prevent another. Aspirin can be considered to prevent atherosclerotic cardiovascular disease for people ages 40-70 who do not have an increased bleeding risk.

Your health care professional will consider your overall health and risk factors for heart attack before prescribing aspirin therapy. If you’re over 70, taking aspirin to prevent a first heart attack or stroke could do more harm than good.  

Know the risks

Because aspirin thins the blood, it can cause some complications. Tell your health care team if any of these situations apply to you. You should not take daily low-dose aspirin without talking to your health care professional if you:

• Have an aspirin allergy or intolerance
• Are at risk for gastrointestinal bleeding or hemorrhagic stroke
• Drink alcohol regularly
• Are having any simple medical or dental procedures
• Are over age 70

There is a risk of stomach problems, including bleeding, for people who take aspirin regularly. Alcohol use can increase these risks. If you are taking aspirin, ask your health care professional if it is safe for you to drink alcohol in moderation.

People with diabetes who do not have a history of heart attack or stroke may not need aspirin unless their health care team prescribes it as part of their overall treatment plan.

How does aspirin help prevent heart attack and stroke?

Most heart attacks and strokes happen when the blood supply to a part of your heart muscle or brain is blocked. This usually starts with atherosclerosis. This is when deposits of fatty substances, cholesterol, cellular waste products and calcium build up in the lining of an artery. This buildup is called plaque.

Plaque usually affects large- and medium-sized arteries. Plaques can grow large enough to greatly reduce blood flow through an artery. But most of the damage occurs when a plaque becomes fragile and breaks. This causes blood clots to form that can block blood flow or break off and travel to another part of the body. This is called an embolism.

If a blood clot blocks a blood vessel that feeds the heart, it causes a heart attack. A stroke occurs when a blood clot blocks a blood vessel that feeds the brain.

Aspirin helps prevent blood clots from forming.

Some people will be prescribed aspirin combined with another antiplatelet medication. This is known as dual antiplatelet therapy (DAPT) . 

Should I take aspirin during a heart attack or stroke?

If you have heart attack warning signs, call 911 right away. Don’t do anything before calling 911. Don’t take an aspirin and wait for it to relieve your pain. Don’t postpone calling 911.

When you call 911, the operator may recommend taking an aspirin. They will make sure you don’t have an allergy to aspirin or a condition that makes using it too risky. If the 911 operator doesn’t talk to you about aspirin, a health care professional at the hospital Emergency Department will give you an aspirin if it’s right for you.

Taking aspirin isn’t advised during a stroke because not all strokes are caused by blood clots. Some strokes are caused by ruptured blood vessels. Taking aspirin could make these bleeding strokes worse.

What’s the bottom line?

The best way to know if you can benefit from aspirin therapy is to ask your health care professional. You should not start aspirin therapy on your own.

What is dual antiplatelet therapy (DAPT)?

Many people who have had a heart attack or stroke – and people seeking to avoid those events – are treated with dual antiplatelet therapy (DAPT). This means taking aspirin along with a second drug to prevent blood clotting.

DAPT is often prescribed for people who:

• Have had a heart attack
• Are treated with stents in their coronary arteries
• Have coronary artery bypass surgery

Aspirin is an antiplatelet agent. A second type of antiplatelet agent, called a P2Y₁₂ inhibitor, is usually prescribed for months or years in addition to aspirin.

You may be prescribed one of the following:

• Clopidogrel
• Prasugrel
• Ticagrelor
• Ticlopidine
• Cangrelor

Which one you take and how long you take it depends on your risks for heart attack, stroke or other cardiovascular events and other factors.

The costs of each medication differ as well, which is another factor to discuss with your health care professional.

How long will I need to be on DAPT?

How long you need to take this medication depends on why it’s prescribed and your risk of blood clots and bleeding. It’s important to take the medication as prescribed.

• Heart attack: You should be on it for at least a year. If your bleeding risk is low, taking it longer may reduce future heart attack risk.
• Bare metal stent: If you are a high bleeding risk, you might take a P2Y₁₂ inhibitor for a shorter time. If your bleeding risk is low and you have a drug-eluting stent, you may be    on DAPT for 6-12 months or longer. Taking it longer can lower the risk of future heart attacks and clots in the stent.
• Coronary artery bypass graft surgery: You may need a P2Y₁₂ inhibitor for a year after surgery.

What interactions do I need to be aware of?

People on DAPT should be aware of interactions that can happen when taking multiple medications, including over-the-counter medications.

Ibuprofen and other non-steroidal inflammatory drugs can lead to problems with P2Y₁₂ inhibitors. Many other drugs – and some foods – can interact negatively with medications. For example, grapefruit can affect the way some cholesterol medications work. And some blood thinners and anticoagulants, such as warfarin, can react to over-the-counter drugs such as ibuprofen.

What if I struggle to pay for medication?

If you’re having trouble paying for your medication, there are a few things you can do to get help.

• Ask if there is a similar medication that costs less.
• Talk to your doctor, pharmacist or other health care professional about your situation. They may know about programs that can help you get your medication for free or at a lower cost.
• Check if the company that makes your medication offers patient assistance programs. Many drug companies have programs that provide medications if you face financial difficulties or are uninsured.
• Look into government programs such as Medicaid or Medicare. They can help cover the cost of medications for eligible people.
• You can use the ·¬ÇÑÊÓƵ’s FindHelp, which will connect you to resources in your community, including financial assistance and housing.