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Aspirin and heart disease

Current guidelines recommend that people with coronary artery disease (CAD) receive antiplatelet therapy with either aspirin or clopidogrel.

Aspirin therapy is very helpful for people with CAD or a history of stroke. If you have been diagnosed with CAD, your health care provider may recommend that you take a daily dose (from 75 to 100 mg) of aspirin. A daily dose of 81 mg is recommended for people who have had angioplasty (also called PCI). It is most often prescribed along with another antiplatelet medicine. Aspirin can reduce the risk for heart attack and ischemic stroke. However, using aspirin over the long-term can raise your risk for stomach bleeding.

Daily aspirin should not be used for prevention in healthy people who are at low risk for heart disease. You provider will consider your overall medical condition and risk factors for heart attack before recommending aspirin therapy.

How Aspirin Helps you

Taking aspirin helps prevent blood clots from forming in your arteries and may help lower your risk for a stroke or heart attack.

Your provider may recommend to take daily aspirin if:

  • You do not have a history of heart disease or stroke, but you are at high risk for a heart attack or stroke. (These recommendations sometimes change as new information becomes available.)
  • You have been diagnosed with heart disease or stroke already.

Aspirin helps get more blood flowing to your legs. It can treat a heart attack and prevent blood clots when you have an abnormal heartbeat. You probably will take aspirin after you have treatment for clogged arteries.

Developmental process of atherosclerosis

You will most likely take aspirin as a pill. A daily low-dose aspirin (75 to 81 mg) is most often the first choice for preventing heart disease or stroke.

Talk to your provider before taking aspirin every day. Your provider may change your dose from time to time.

Side Effects

Aspirin can have side effects such as:

  • Diarrhea
  • Itching
  • Nausea
  • Skin rash
  • Stomach pain

Before you start taking aspirin, tell your provider if you have bleeding problems or stomach ulcers. Also say if you are pregnant or breastfeeding.

Taking Aspirin

Take your aspirin with food and water. This can reduce side effects. You may need to stop taking this medicine before surgery or dental work. Always talk to your provider before you stop taking this medicine. If you have had a heart attack or a stent placed, be sure to ask your heart doctor if it is OK to stop taking aspirin.

You may need medicine for other health problems. Ask your provider if this is safe.

If you miss a dose of your aspirin, take it as soon as possible. If it is time for your next dose, take your usual amount. Do not take extra pills.

Store your medicines in a cool, dry place. Keep them away from children.

When to Call the Doctor

Contact your provider if you have side effects.

Side effects can be any signs of unusual bleeding:

  • Blood in the urine or stools
  • Nosebleeds
  • Unusual bruising
  • Heavy bleeding from cuts
  • Black tarry stools
  • Coughing up blood
  • Unusually heavy menstrual bleeding or unexpected vaginal bleeding
  • Vomit that looks like coffee grounds

Other side effects can be dizziness or difficulty swallowing.

Contact your provider if you have wheezing, breathing difficulty, or tightness or pain in your chest.

Side effects include swelling in your face or hands. Contact your provider if you have itching, hives, or tingling in your face or hands, very bad stomach pain, or a skin rash.

Alternative Names

Blood thinners - aspirin; Antiplatelet therapy - aspirin

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References

Bohula EA, Morrow DA. ST-Elevation Myocardial Infarction: Management. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 38.

Giugliano RP, Braunwald E. Non-ST Elevation acute coronary syndromes. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 39.

Kumbhani DJ, Bhatt DL. Percutaneous coronary intervention. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 41.

Morrow DA, de Lemos J. Stable Ischemic Heart Disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Mora S, Libby P, Ridker PM. Primary prevention of cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 25.

US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. Aspirin use to prevent cardiovascular disease US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577-1584. PMID: 35471505 pubmed.ncbi.nlm.nih.gov/35471505/.

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Patient Instructions

Review Date 8/5/2024

Updated by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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