The Popular One-Aspirin-Per-Day Myth

From the December 2002 edition of Dr. Fuhrman's Healthy Times:

There have been so many misleading media reports stating that taking an aspirin every day is a good way to prevent heart attacks that most people are starting to believe it. Here is an example of the typical conversation I have with other physicians on the subject.

“Dr. Fuhrman, do you take an aspirin every day to prevent heart attack?”

“No, of course not,” I respond.

“Haven’t you read the reports about it in the New England Journal of Medicine?”

“I’ve read them.”

“Then why don’t you practice what you preach.”

“Don’t you mean, ‘Why don’t I practice what you preach?’ I don’t recommend taking aspirin. I recommend eating so healthfully that taking aspirin is not necessary.”

At that point, the fireworks usually begin. Since I don’t enjoy arguing, I’ve decided to describe my thinking here. That way, the next time I’m at a meeting with other physicians, I can hand them a copy of this newsletter and avoid inciting a riot, where I might get attacked with flaming shish kebabs or doused with blazing hot cheese fondue.

Leading Cause of Death

Cardiovascular disease is the leading cause of death in the United States. Every year, more than one million Americans die of heart attacks. The saddest aspect of this enormous suffering is that virtually all of these deaths are unnecessary. With very few exceptions, nobody is predestined to have a heart attack. Heart disease is easily preventable, but not by taking aspirin.

I am aware that the U.S. Preventive Services Task Force has recommended that individuals at high risk of heart attacks take aspirin as a preventative. But even if I agreed with their theory that taking aspirin was an effective way to prevent premature death from heart disease, I wouldn’t recommend it to as many people as they do. According to the Task Force, those at high risk include: men over forty years of age, postmenopausal women, and younger individuals who have high blood pressure or high cholesterol or who smoke. That is quite a broad definition of high risk. It includes almost everybody I know, except my wife and children.

Increased Sudden Death

Aspirin for prevention of heart attacks was first touted after the landmark Physicians Health Study1 found that aspirin decreased the heart attack rate in asymptomatic physicians during a five-year period. That sounds like good news until you realize that overall mortality (death) was not decreased and sudden death was increased. Oops. Sudden death is not a desirable side effect.

The British did a similar study in 1988, which also found no reduction in mortality. After the U.S. Preventive Services Task Force reviewed this and other data, they modified their guidelines and noted that no added benefit, only added risk, has been documented in doses of aspirin greater than 75 mg per day.

Five studies to date have examined the effects of daily or every-other-day aspirin use for primary prevention for periods of four to seven years.2 Most participants were men older than 50 years. Meta-analysis of the pooled data from all of the studies show that aspirin therapy reduced risk for coronary events by 28 percent, but with no decrease in mortality. In other words, aspirin use did not result in longer life. There was no reduction of death due to heart attack or stroke. Further, there was evidence of an increased risk of hemorrhagic stroke and a two- to four-fold increase in gastrointestinal complications, including ulcers and bleeding.

Based on this unimpressive data, and in spite of pooled data that shows for most adults, aspirin therapy causes more harm than good,3 most Americans take it for granted that taking an aspirin every day will prevent heart disease.

Advice on aspirin for prevention against heart attacks and stroke must be based on each individual’s cardiac risk. For those at very high risk, with known risk factors such as the conventional, high-saturated fat, low-nutrient diet, high blood pressure, high cholesterol and overweight, the benefits of aspirin may outweigh the risk. But for those of us who eat healthfully, exercise and don’t smoke, taking aspirin will increase our risk of cerebral hemorrhage and other bleeding complications.

For healthy people, the risks outweigh the benefits. That is why, in contrast to typical physician recommendations aimed at reducing risk, I recommend that people eliminate their risk factors. Daily aspirin consumption is for those satisfied with mediocrity and willing to gamble with their lives.
1. Steering Committee of the PHS Research Group final report on the aspirin component of the ongoing Physicians Health Study. N Engl J Med 1989:321(3)129-135.

2. U.S. Preventive Services Task Force (USPSTF) Aspirin for the Primary Prevention of Cardiovascular Events. Recommendations and rationale. January 2002. Agency for Healthcare Research and Quality, Rockville, MD.

3. Sanmuganathan PS, Ghahramani P, Jackson PR, et al. Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomized trials. Heart 2001;85(3):265-271.
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Comments (2) Read through and enter the discussion with the form at the end
Jim Carrillo - December 8, 2008 3:53 PM

Thanks for the article.

As stupid as it sounds, I was actually thinking of taking an aspirin a day until I found the time to live a healthier life. I think that summarizes the exact negative effects that the promotion of an aspirin a day can have.

For some reason, I believed it would be a substitute for living well.

Your article re-enforced what I should have already known; live healthy, be healthy.


"Soon to be 40" Jim

AIrelon - January 3, 2009 8:33 AM

I read the study, and it really doesn't "prove" anything, one way or the other.

And the story in the beginning was extremely circular.

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