Donald Trump recently said he takes aspirin every day, adding that he needs it “psychologically” and believes it “thins” the blood. The comment raises a familiar question: if aspirin can reduce the risk of some heart attacks, why isn’t everyone taking it?The answer is more complicated than a daily pill. Aspirin can protect some people, but it can also cause serious bleeding.
Aspirin is not exactly a blood thinner
“Aspirin is often called the blood thinner, but technically it’s an antiplatelet, not an anticoagulant,” cardiologist Dmitry Yaranov, MD, explained in the video.At low doses, such as 81 mg, aspirin makes platelets less likely to stick together and form clots. That can help prevent some clot-related heart attacks and ischemic strokes. But the same action can make bleeding harder to stop.
The biggest difference: first heart attack or another one?
For someone who has already had a heart attack, ischemic stroke or certain procedures such as coronary stenting, aspirin may be prescribed to reduce the chance of another clot-related event. This is called secondary prevention.But someone who has never had such an event is considering aspirin for primary prevention. Here, the possible benefit has to be weighed against the risk of bleeding.That distinction is easy to miss when aspirin is viewed simply as a heart-protection pill.
Healthy older adults may not benefit
The ASPREE trial, supported by the US National Institutes of Health, studied more than 19,000 healthy older adults. Daily low-dose aspirin did not significantly reduce cardiovascular disease, but major bleeding was higher among those taking aspirin.That evidence helped shift thinking around routine aspirin use in older adults.The US Preventive Services Task Force guidance recommends against starting aspirin for primary prevention in adults aged 60 and older. For adults aged 40 to 59 with a 10% or greater 10-year cardiovascular risk, the decision should be individualised.
Who might actually benefit?
There is no universal “aspirin age” or dose that works for everyone.According to Dr Yaranov, some adults aged 40 to 60 with a higher cardiovascular risk may be considered for aspirin after discussing the benefits and bleeding risks with a clinician.Factors such as previous ulcers or bleeding, other medicines, age and overall cardiovascular risk can change that calculation. Being available over the counter does not make aspirin risk-free.
The takeaway from Trump’s aspirin comment
Aspirin may be an important medicine for someone who has already experienced a cardiovascular event. It is a different story for a healthy person hoping to prevent a first heart attack.So, taking aspirin simply because someone else does, even a president, is not a safe way to make a heart-health decision.Anyone already prescribed aspirin after a heart attack, stroke or stent should not stop it without speaking to the treating clinician. Those considering daily aspirin should discuss the decision with a doctor or pharmacist first.