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Doctor’s Tip: The latest on taking daily aspirin to prevent heart attacks and strokes

Dr. Greg Feinsinger

Aspirin (salicylic acid), in the form of willow bark extract, has been used for thousands of years for pain, fever, and inflammation. It has been available in pill form since 1897. Salicylic acid is also present in many fruits and vegetables, with the highest concentration being in herbs and spices, particularly chili powder, paprika, and turmeric.

Aspirin has anti-clotting properties, and daily 81 mg. baby aspirin has been used for years for heart attack and stroke prevention. Heart attacks and most strokes are caused when plaque in the walls of coronary or brain arteries ruptures, resulting in a blood clot that blocks blood flow; aspirin helps prevent the blood clot from forming. It’s important to put this in perspective, though. The value of aspirin to prevent heart attacks pales in comparison to getting cholesterol, blood pressure, blood sugars, and weight to goal, and regular exercise and tobacco avoidance.

Like all medications, aspirin in pill form can have side effects: stomach ulcers; life-threatening stomach bleeding; and hemorrhagic strokes (where a blood vessel in the brain ruptures). So, people with high risk of bleeding should not take aspirin, nor should people at very low heart attack risk — where the risk of serious side effects outweighs the potential benefit.



Recommendations for daily aspirin have varied over the years, and many people took daily aspirin just because they’d heard it was a good thing to do. Recently, the guidelines were revised.

NEW, 2022 GUIDELINES: 1. People with a history of a heart attack, stroke, coronary stent, or atrial fibrillation should continue to take 81 mg. of aspirin daily (This is what’s called secondary prevention). Some guidelines add anyone with a coronary calcium score (a CT scan of the heart, which measures the amount of calcified plaque in coronary arteries) over 100, since they are at high risk for a heart attack. 2. Adults over 59 should not take daily aspirin for primary prevention (prevention of first heart attack) because risk outweighs the benefit. 3. People with increased risk of stomach or brain bleeding should avoid aspirin. 4. People age 40-59 with cardiac risk facts such as diabetes, smoking, hypertension, high cholesterol, or positive family history of heart disease should talk to their physician about the pros and cons of taking daily aspirin. 5. People with a 10% or greater 10-year risk of a heart attack — based on a risk calculator — should talk to their doctor.



BALE-DONEEN METHOD RECOMMENDATIONS: This is one of the most successful heart attack and stroke prevention programs in the country, and Brad Bale, M.D. and Amy Doneen, DNP came out with their second book in 2022 called “Healthy Heart, Healthy Brain.” They feel the aforementioned risk calculator is inaccurate and have the following recommendations:

1. “The effectiveness of low-dose aspirin for people who have already suffered one or more heart attacks or strokes remains undisputed, and they call this tertiary prevention.

2. They consider primary prevention to be prevention of heart attacks in people with no history of a cardiovascular event (heart attack or stroke), no significant risk factors, AND no evidence of hardening of the arteries based on coronary calcium score and/or carotid IMT. In these people, the potential harm from taking daily aspirin clearly outweighs any potential benefit.

3. They use the term secondary prevention for people with no history of heart attack or stroke but with proven plaque — no matter what their risk factors (Although, most people with significant risk factors have plaque in their arteries).

4. Bale and Doneen point out that some people who have the indications for daily aspirin are resistant to 81 mg. and need higher doses or in some cases a different anticoagulant such as Plavix. They recommend that all people on aspirin to prevent a heart attacks and strokes have an inexpensive urine test called AspirinWorks to check for “aspirin resistance.”

DOCTOR GREGER’S TAKE: He is famous for his books including “How Not to Die,” and his website nutritionfacts.org. He recommends that people get their aspirin not through a daily pill but rather through daily intake of fruits and vegetables such as the ones noted in the first paragraph, which provide the benefit of aspirin without the possible side effects. He points out that “in plants, the salicylic acid appears to come naturally prepackaged with gut-protective nutrients, such as nitric oxide, that boosts blood flow and protective mucus production in the lining of the GI tract.”

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.


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