Aspirin – good or bad?

Dr Malik says: It is not an easy question.

Aspirin has been used for decades. It has solid evidence for use at 75-300mg per day if you have already had a cardiovascular event such as a heart attack or stroke. However, what if you have yet to have one? The data is mixed. Prevention is not all about drugs!

1. Lifestyle modification:

  • Increase physical activity including aerobic, strength, and core exercises- 10,000 steps a day
  • Develop heart-healthy dietary practices- the 5-a-day fruit and vegetables. Perhaps the 5-2 diet plan. Reducing sugar
  • Stop smoking and avoid secondhand smoke
  • Reduce stress- easier said than done. Exercise relieves stress.
  • Improve sleep quantity and quality- for most people at least 7 hours a day.
  • Reduce alcohol use- it has calories, it disturbs sleep, it raises blood pressure.

2. Medication:

  • Antihypertensive drugs to optimize blood pressure- after low sodium diet, weight loss, exercise etc
  • Lipid-lowering therapies (statins) to reduce LDL cholesterol- primary prevention works. The data is more robust than for aspirin and the risks of therapy are lower.
  • Nicotine replacement and adjuncts for smoking cessation- anything to stop smoking-e-cigarettes are bad for you, but 100x better than smoking.
  • Treatment of mental health conditions in part to facilitate health behavior change- depression has major cardiovascular risk.
  • Low-dose aspirin- so what should we do?

We should chat about it. For some it will have benefit. For others, the bleeding risk outweighs the benefit.

See this handy infographic for more detail:

Posted on 05 August 2019
Author: Dr Iqbal Malik

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