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.
- 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: