Harvard Health Letter

Ask the doctor: Questioning the necessity of aspirin

Q. My doctor recently advised me to start taking an 81-mg aspirin once a day. I am a physically active 62-year-old and have been a vegetarian — mostly vegan — for 35 years. My BMI is less than 24, my HDL is over 70, and my Framingham risk score is 8%. My only problems are systolic blood pressure in the 130s and an occasional episode of arrhythmia. I'd really rather not take aspirin. Am I being foolish in questioning my doctor's advice?

A. It's not foolish to question your doctor's advice. You need to understand the reasoning and the facts behind a doctor's advice, particularly when you wonder if the advice really applies to you. In this case, you think it doesn't — and judging by the information you've provided, I am inclined to agree with you.

Aspirin makes platelets in the blood less "sticky," so they're less likely to bunch up into the artery-clogging clots that form when an atherosclerotic plaque ruptures and its contents spill into the bloodstream. There's very good evidence now from many studies that regular use of aspirin can lower the risk of having a heart attack in people who have known atherosclerosis in the coronary arteries, the blood vessels that supply the heart. Regular aspirin use can also lower the risk of stroke in people with atherosclerosis in the arteries that supply the brain. The 81-mg dose your doctor recommended is the standard one for cardiovascular protection.

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