When it comes to aspirin and heart protection, does dose matter?

Taking aspirin daily as protection against recurring heart attacks and stroke has gotten a bit of a bum rap in recent years. Heart health experts caution that aspirin’s antiplatelet action can increase the risk of bleeding in some people, but research has actually been inconclusive on this front.

Despite the risks, aspirin remains a commonly recommended medicine for the prevention of another heart attack, stroke or premature death in people who have had a heart attack or a heart procedure like stent placement or bypass surgery.

Usually, when daily aspirin is prescribed, the recommended dose is 81 mg, the amount found in “baby” aspirin. But researchers have been exploring whether it might be best to prescribe regular-strength aspirin, which at 325 mg is four times as strong as baby aspirin.

So far, findings have been mixed. Some studies have indicated 81 mg reduces the risk of bleeding, while 325 mg offers more effective heart attack and stroke prevention. But of all the studies conducted, none has directly compared these dosages — until now…

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Comparing low-dose and high-dose aspirin for daily heart protection

Results of a recent study presented at the American College of Cardiology’s 70th Annual Scientific Session finally has answers for anyone unsure about the benefits of aspirin for heart health, especially when it comes to dosage.

The ADAPTABLE study involved 15,076 patients with pre-existing cardiovascular disease and was designed to determine the optimal daily aspirin dosage to effectively lower the risk for heart attack, stroke and death. The study also aimed to weigh the risk of major bleeding.

“There really hasn’t been a clear answer about what is the most effective and safe dose of aspirin for these patients,” says Dr. Schuyler Jones, lead author of the study and assistant professor of medicine at the Duke Clinical Research Institute (DCRI). “However, these earlier studies have primarily investigated aspirin — either 81 or 325 mg daily dose — compared with placebo, whereas ADAPTABLE was a direct comparison of the two doses.”

Here’s what they found…

  • The study showed no significant difference in cardiovascular events or major bleeding between the 81 mg and 325 mg daily doses of aspirin.
  • The study measured aspirin’s effectiveness as a composite of all-cause death or hospitalization for heart attack or stroke. This outcome occurred in 590 patients in the 81 mg group and 569 patients in the 325 mg group.
  • And, despite the worries surrounding aspirin and bleeding, it turned out to be a rare occurrence. In fact, any bleeding that required hospitalization only occurred in 53 of the participants taking baby aspirin and 44 of the participants taking regular-strength aspirin.

These results remained consistent across subgroups of patients regardless of age, race/ethnicity, gender, previous use of dual antiplatelet therapy, or coexisting diabetes or chronic kidney disease.

Although participants were randomized to a particular aspirin dose and encouraged to stay on that dose, they were able to switch doses if they wanted.

In the group of patients taking a 325 mg dose, 41.6 percent chose to switch to the lower dose. Some patients may have switched because of issues tolerating the higher dose, but researchers surmised that many other factors likely contributed to participants’ desires to change dosage including news about other studies, DAPT recommendations, personal beliefs and clinician preferences. Only 7.1 percent of participants taking the 81 mg dose decided to switch to the higher dose.

Some of the participants also chose to stop taking aspirin completely during the study, with 11 percent discontinuing aspirin in the 325 mg group and 7 percent in the 81 mg group.

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Bottom line: What dosage would the researchers recommend? Jones says because of the lack of difference between the two doses in terms of safety and effectiveness, the research team thinks the 81 mg dose is the best choice for patients because it has better long-term adherence.

The changing recommendations for daily aspirin use

Use of aspirin to prevent heart attack and stroke has evolved in recent years. According to the American Heart Association, people with a history of heart attack or stroke should speak with their doctor before taking a low daily dose of aspirin to prevent another from occurring. The doctor will be able to advise whether an aspirin regimen should be part of their treatment plan.

Obviously, if you’re allergic to aspirin you shouldn’t use it at all. And there are other cases when taking aspirin daily can do more harm than good. For instance, if you’re over 70, taking aspirin every day to prevent heart attack or stroke could raise your risk of bleeding. This heightened bleeding risk is also why aspirin therapy is no longer recommended for people who have never had a heart attack or stroke.

Daily use of aspirin is also cautioned in people at risk of gastrointestinal bleeding or hemorrhagic stroke, or in those undergoing simple medical or dental procedures. Also, if you regularly drink alcohol, you shouldn’t take aspirin every day.

If you’ve never had a heart attack and want to keep it that way, the best thing you can do for yourself is to eat a heart-healthy diet that limits salt and includes plenty of fruits, vegetables, whole grains, lean meats and healthy unsaturated fats like olive oil. We’ve also observed the benefits of supplements like coenzyme Q10 (CoQ10) and vitamin D on heart health.

As for stroke, we’ve written before about the best foods and supplements to consume for stroke prevention. Examples of good supplements to help ward off stroke are nattokinase, which reduces blood clots, and garlic, which lowers arterial plaque development as well as reducing blood clotting.

Editor’s note: There are numerous safe and natural ways to decrease your risk of blood clots including the 25-cent vitamin, the nutrient that acts as a natural blood thinner and the powerful herb that helps clear plaque. To discover these and more, click here for Hushed Up Natural Heart Cures and Common Misconceptions of Popular Heart Treatments!


Baby and Regular-Strength Aspirin Work Equally Well to Protect Heart Health — American College of Cardiology

Aspirin and Heart Disease — American Heart Association

Heart-healthy diet: 8 steps to prevent heart disease — Mayo Clinic

Carolyn Gretton

By Carolyn Gretton

Carolyn Gretton is a freelance writer based in New Haven, CT who specializes in all aspects of health and wellness and is passionate about discovering the latest health breakthroughs and sharing them with others. She has worked with a wide range of companies in the alternative health space and has written for online and print publications like Dow Jones Newswires and the Philadelphia Inquirer.