Aspirin for Heart Health? Is There A Better Way?

"Take an aspirin daily to prevent heart problems!"

This piece of advice is tossed out there frequently - maybe even at you by your doc!

But do the pros of aspirin as a preventative measure for cardiovascular complications outweigh the cons of the medication's side effects?

Let's take a look at what large-scale meta-analyses (highest-quality studies) have to say! ...

They concluded that aspirin may have anywhere from no significant cardiovascular death risk-lowering benefit up to a 9% reduction in cardiovascular events or a 13% reduction in heart attacks. With those potential pros, we now consider the cons: 30% to 57% increased risk of major GI bleeding (Zhao et al., 2021).  

Additionally, new research shows Aspirin and other Non-Steroidal-Anti-Inflammatory meds (NSAIDs) can cause the following problems in the gut  (Maseda, 2020; Zádori et al., 2023):

1 - Dysbiosis - significant shifts to the gut microbiome

2- Impaired gut lining, AKA "leaky gut" (Highly connected to immune system dysfunction)

3- Impaired motility (movement of food through the gut)

LET'S MAKE SENSE OF ALL THAT!

Cardiovascular events are a leading cause of death (Mc Namara et al., 2019), so measures to reduce could be a big win!

However, GI bleeding can also be very serious, leading to hospitalization and death. For example, a recent study states that GI bleeding results in up to 300,000 annual hospitalizations and 30,000 annual deaths in the U.S., with a 30-day mortality rate of 6% and 14%.

Plus, regarding the aspirin-induced shifts in the gut... Decades of research support the notion that disease states -- ranging from Alzheimer's to Allergies to Autoimmunity-- trace back to issues in the gut! Accordingly, the latest research suggests that long-term NSAID/aspirin use contributes to significant health problems (Maseda, 2020; Zádori et al., 2023).

Remember, everything in the body is all connected! So to truly improve your mental health, heart health, weight loss, fatigue, hormones, or you name it, we MUST address matters like this that collectively keep your body stuck in a state of being off balance!

I know what you might be thinking... But popping a pill sounds SO much more convenient than making heart-healthy lifestyle changes! I like to bring the platitudes "Nothing is free" in here! But we may be able to partially accommodate by bringing in an EPA/DHA omega-3 fish oil supplement!

A 2021 systematic review/meta-analysis reported that EPA-based omega-3 interventions were associated with lower cardiovascular mortality (RR 0.82) and fewer coronary heart disease events (RR 0.73) (Khan et al., 2021). That corresponds to an 18% and 27% relative reduction in those outcomes in that analysis.

However, a blanket statement to supplement with omega 3s may not work for some, as ultimately it is about the BALANCE of all different types of omega 3s and omega 6s that is driving inflammation and thus cardiovascular health. Thus, what I do with my clients is run an RBC Omega Index test to tailor the dose and duration to that person's individual levels.

Now just imagine if you combined this with regular exercise and healthy eating! A whole-food diet rich in veggies, fruits, monounsaturated fats (olive oil and avocados), vitamin E rich foods (sunflower seeds, almonds, olives, avocado) and high-quality protein (especially fish) can significantly improve heart health. This describes a "Mediterranean-style diet", shown in large-scale reviews to reduce cardiovascular events by 10% (Sofi et al., 2010)!

So here are the takeaways:

• Potential 9% to 13% reduction in cardiovascular events and heart attacks with aspirin
• Serious downsides of long-term aspirin exposure can include GI bleeding and gut barrier/microbiome disruption, which may contribute to inflammation and negative symptoms—especially in people with gut issues.
• Potential 18% to 27% lower likelihood of heart-related death and disease with high-quality fish oil containing EPA
• Tons of other health benefits of fish oil including better brain health and a healthy immune system
• Potential 10% lower likelihood of cardiovascular events with a Mediterranean-style diet
  

A high-quality omega-3 fish oil supplement containing EPA (dose and duration individualized to lab tests), combined with a healthy diet (with whole turmeric root, vitamin E-rich foods, vegetables and monounsaturated fats) and exercise could be a superior solution for most interested in taking cardiovascular-related preventative measures!

In particular, if you’re 60+ and have never had a heart attack or stroke, many guidelines advise not starting daily aspirin for primary prevention because bleeding risk often outweighs benefit.

Remember, you MUST discuss with your doctor what is best for YOUR unique situation.

References:

Khan, S. U., Lone, A. N., Khan, M. S., Virani, S. S., Blumenthal, R. S., Nasir, K., Miller, M., Michos, E. D., Ballantyne, C. M., Boden, W. E., & Bhatt, D. L. (2021). Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis. EClinicalMedicine, 38, 100997. https://doi.org/10.1016/j.eclinm.2021.100997

Mc Namara, K., Alzubaidi, H., & Jackson, J. K. (2019). Cardiovascular disease as a leading cause of death: how are pharmacists getting involved?. Integrated pharmacy research & practice, 8, 1–11. https://doi.org/10.2147/IPRP.S133088

Sofi, F., Abbate, R., Gensini, G. F., & Casini, A. (2010). Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. The American journal of clinical nutrition, 92(5), 1189–1196. https://doi.org/10.3945/ajcn.2010.29673

Wilcox, C. M., Cryer, B. L., Henk, H. J., Zarotsky, V., & Zlateva, G. (2009). Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting. Clinical and experimental gastroenterology, 2, 21–30. https://doi.org/10.2147/ceg.s4936

Zhao, B., Wu, Q., Wang, L., Liao, C., Dong, Y., Xu, J., Wei, Y., & Zhang, W. (2021). Pros and Cons of Aspirin for the Primary Prevention of Cardiovascular Events: A Secondary Study of Trial Sequential Analysis. Frontiers in pharmacology, 11, 592116. https://doi.org/10.3389/fphar.2020.592116

Zádori, Z. S., Király, K., Al-Khrasani, M., & Gyires, K. (2023). Interactions between NSAIDs, opioids and the gut microbiota - Future perspectives in the management of inflammation and pain. Pharmacology & therapeutics, 241, 108327. https://doi.org/10.1016/j.pharmthera.2022.108327