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Maybe You Should Rethink That Daily Aspirin

For all the good aspirin can do in preventing second heart attacks and strokes, taking it daily can boost some risks, too — of ulcers, for example, and of bleeding in the brain or gut.

We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't.

In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people wh have already experienced such an event or are at extremely high risk.

The survey, published in the American Journal of Preventive Medicine, found that 52 percent of people ages 45 to 75 are taking aspirin daily or every other day. And 47 percent are taking it even though they have never had a heart attack or stroke.

"That's very controversial in the medical community," says Craig Williams, a pharmacologist at Oregon State University, who led the study.

Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain.

"Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk," Williams says.

But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests.

The American Heart Association says aspirin should be used only for prevention when someone's risk for heart disease is especially high.

And Williams says that the U.S. Preventive Services Task Force is in the process of revising its recommendation, which currently holds that older men and women should generally take aspirin if their risk for heart attack outweighs the risk of bleeding due to the medication.

In the survey by Williams' team, about 43 percent of people said they were taking the drug for prevention without having consulted a physician. That's a bad idea, says Steve Nissen, a cardiologist at the Cleveland Clinic who wasn't involved in the study.

"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well,' " Nissen says. "They are perfectly healthy. They may not even have a lot of risk factors. But they're very health conscious. And somebody told them that aspirin was good for preventing heart attacks, so they just started taking it."

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