Early in my career when I was running through hospital halls, coat tails flying behind me, headed to help someone in cardiac arrest—I pondered whether an aspirin a day could prevent these types of calamities. It was the 1980’s and there wasn’t a hard-working doctor who didn’t worry about having their own heart attack. Knowing that aspirin had the power to thin the blood, many doctors began adding it to their daily regimen.

Later on, once the efficacy was confirmed, it was decided an 81 mg baby aspirin could replace the hefty 325 mg adult dose. Bayer, the largest producer of aspirin, jumped at the chance to promote its pain reliever as the “wonder drug” that could prevent heart attacks, even in healthy individuals. Doctors began prescribing it to virtually every patient they had.

Now, a new meta-analysis of 9 placebo-controlled trials challenges that practice. This month, the Archives of Internal Medicine published data collected from 100,000 people over six years showing that we have to treat 120 people with an aspirin a day to prevent just one nonfatal myocardial infarction (MI).

The researchers did report that total cardiovascular events decreased by 10%.  But at the same time there was a 30% increased risk for “trivial bleeding events.”  Because it took treating just 73 people to trigger that bleeding event, we must think twice about our overzealous use of aspirin.

So, what’s the bottom line for you?

* I don’t recommend an aspirin for primary prevention. While an aspirin a day prevents clot formation, the final step that triggers a heart attack, it doesn’t change atherosclerotic plaque which is the underlying cause of heart disease.

A far better way to prevent a heart attack is by keeping plaque from forming and building up in the first place.  That means back to basics: a healthy diet, exercise, weight reduction, nutritional support with antioxidants and anti-inflammatories, blood pressure lowering, stress reduction, and so on.

* But taking an aspirin a day for secondary prevention—if you’ve already had a heart attack or have a history of cardiovascular disease—is just plain good medicine. I regularly advocate aspirin for those who have known heart disease, such as a history of angina, heart attack, angioplasty or stent procedures, or coronary artery bypass surgery. In these cases, I recommend taking one baby aspirin daily.

But even if you have all the characteristics I just mentioned that would make you a perfect candidate for a daily preventative aspirin regimen, it won’t do you a lick of good if you’re part of the population known as “aspirin-resistant.” Fortunately, there’s a test to determine if an aspirin a day will work for you.

Now it’s your turn: What do you think about taking an aspirin a day?

You May Also Be Interested In:

• How to Use Aspirin if You Think You’re Having a Heart Attack
• Blood Thinners 101