March 28, 2023

Dr. Stephen Kopecky, a cardiologist at Mayo Clinic, answers this question: Does aspirin help prevent stroke and heart attacks? This interview originally aired Sept. 15, 2018.

Welcome back to mayo clinic radio i’m dr. tom shives you know there are millions of americans who are taking an aspirin every day to hopefully prevent a heart attack or a stroke but some of the latest studies suggest that if you have never had a heart attack or a stroke taking an aspirin a day may not be worth it may not work as well as we thought at what may not

Work as well as we thought time for a mayo clinic expert opinion joining us in studio is mayo cardiologist heart specialist dr. stateman kopetski dr. kopetsky good to have you back especially today because these new studies have come out that questioned whether or not people ought to be taking an aspirin every day if they’ve never had a stroke or a heart attack what

Do you think thank you tom the that’s a very interesting question in a couple of these studies that came out came with conclusions that didn’t help well it’s not for everybody that’s for sure but there are some people that help now we know for years that aspirin reduces the risk of stroke in women but not men first stroke aspirin reduces the risk of heart attack in

Men but not women so men and women are equal but we’re different obviously in our response to aspirin now in the studies you’re talking about a couple of things one is the ones that are presented in european congress of cardiology they tried to get people that were had at least a risk of 10% for a stroke or heart attack over the next ten years and they enrolled

Them and found no difference well they what they found in retrospect was that found that they asked but didn’t do anything with regard to prevention of stroke or heart attack that’s right okay and what they found though was that they actually enrolled patients that only had a nine percent risk of stroke or heart attack so they enrolled lower risk patients than

They planned now the guidelines in this country in the u.s. are to recommend or consider aspirin for people that have a risk over 10% which is the reason they did the study over ten percent okay but if if they didn’t have the risk over 10% it probably doesn’t help them and that’s what the study showed okay so how do you find out you put the risk in in percentage

Terms how do you find out what your risk is yeah that’s a good question there are a couple places you can go online you can go to the american college of cardiology or the american heart association both have their they’re connected and it is called the acc aah a risk calculator plus you just type that into your into your search engine on your computer and actually

Just look up risk calculator plus and it’ll come up and it’ll ask you some questions what’s your blood pressure what year were you born what’s your gender what’s your cholesterol you do need to know your cholesterol levels and you know your blood pressure you know your blood pressure cholesterol and cholesterol and be helpful to know if you’re on medicines for blood

Pressure and things like that okay if you have diabetes or on medicines for diabetes then you tell them this and it will tell you what’s your risk then for a fatal or a non-fatal heart attack or stroke over the next ten years well how does it know whether it’s gonna be fatal or not well it doesn’t it just groups all together okay all right and then you are saying

That if that figure comes out to ten percent or above even if you’ve never had a heart attack or a stroke you should consider taking an aspirin every day you should consider taking an aspirin however there’s always a risk of bleeding we know that as you go through life your risk of heart attack and stroke goes up but as you go through life your risk of bleeding

On aspirin also goes up the question is what goes up faster and it’s actual fact is that your risk of bleeding on aspirin goes up faster than your bleeding than your risk of heart attack or stroke no kidding so this is stomach bleeding because the aspirin irritates the gastric lining the stomach lining primarily yeah or sometimes very rarely interred in your head

Bleeding so how do you decide well how you decide you there are its helps to talk to your provider your primary care provider there are certain apps out there you know bleeding apps you can actually go on your phone and say what’s my risk of bleeding we use it all the time in the hospital on hospital service because they are scientifically driven and des found to

Be accurate you mean so how can how can an app tell you what your risk is a bleeding taking an aspirin it asks you again questions like have you ever bled do you have frequent nosebleeds do you take a lot of medications for arthritis like these non-steroidal anti-inflammatory drugs like ibuprofen because that increases your risk of bleeding do you drink alcohol to

Excess and fall down do you walk with a cane do you fall easily so they can actually look and give a pretty good estimate so let me make sure i have this this correct you need to know what your risk is of a fatal or non-fatal heart attack or stroke and you can figure that out by going to the american heart association or the american college of cardiology websites

And then then you put in what risk factor assessment yes it would be risk calculator plus risk calculator plus then it’ll ask you some questions you push the button enter and it will tell you what your risk is for a heart attack or a stroke right ensuing 10 years or in the ensuing 10 years and the nice thing about that particular webpage too is you can say well what

If i go on aspirin what is my risk go down to mmm what if i have high blood pressure and i treat it what does they go down to what if i have diabetes and treated or high cholesterol and treated it’ll actually tell you before and after now these are all predictions we can’t predict the individual patients it’s obviously just an estimate but it gives you a pretty good

Estimate i’ve had patients to the risk is 35% it goes down to 12% by treating their blood pressure taking an aspirin taking care of their cholesterol and when you say taking an aspirin exactly what do you mean how much our baby aspirin want adult aspirin how much yeah the study that was done we just mentioned a minute ago was a hundred milligrams of aspirin that’s

A european thing we don’t have that available here in this country we’re usually 81 or 162 or 325 and the studies have shown that 81 is really good for almost all people there are some recent observational studies which means they just looked at tens of thousands of patients and found that people who are heavier may be needed more aspirin but that’s not written

In stone all right 81 is a baby aspirin and for most people that would be okay adult low-dose aspirin babies don’t take the aspirin all right as long as i’ve got you here i want to ask you a couple of recent headlines and one of them was about diet and it says study claims red meat and cheese aren’t as bad for your diet as previously thought you see the study oh

Yes yes yeah what do you think well this was the the pure study anyone interested done out canada and they did they looked at at numerous countries and every continent except that’s populated except for they in arctica and they looked at a huge population and said that if you eat a higher fat diet higher saturated fat diet you actually had better longevity or less

Chance of dying what they included though was a lot of very very poor people living in low socioeconomic class so they mainly ate very high carb diet like 61% of their of their calories were carbs on average if they could eat more meat which is an expensive very expensive item remember you know ten thousand years ago we didn’t eat meat we didn’t like kill a deer

For breakfast you know meat was a celebratory meaning you would celebrate a wedding a truce of birth something like that you need all the time so they actually found that the eating the meat and eating the cheese the the dairy actually lowered your mortality but it probably was confounded we call it or kind of affected by the people in the study they were not very

Wealthy they didn’t have much money they couldn’t afford you know the normal foods we would eat in this country so if they ate the meat they actually did better so you’re not necessarily saying that’s a good idea i mean you’re still a proponent of the mediterranean diet well it’s very interesting that same group the pure group that was published in lancet just last

Month along with the eric study which is another study they looked at huge populations and they actually came together in pure actually changed its its recommendations the pure group they found that if you eat an average of 50 percent of your calories of as carbohydrates now we would recommend in the mediterranean that’d be legumes fruits vegetables things like

That not you know not processed foods not processed rice pointer etc that that was the low point for mortality if you ate more like 61% like i said earlier they in that in the pure earlier pure study your mortality went up if you ate less carbs your mortality went up so the you know remember your mother said eat a balanced diet tom when you go to school you know

That that’s actually pretty good advice but if you eat a mediterranean balanced diet that’s even better which means about about half carbs now these low-carb diet the fanatics really get excited about that they think that’s way way too much carbs but if you look at the studies eating a low-carb diet increases your mortality and it increases your heart attack rate

All right so you’re still a proponent of the mediterranean everything in moderation right really without that emphasis on fruits and vegetables very very true a plant-based diet and you get three ounces of red meat a day which you know isn’t much but if you go to a steak house and you order a steak and they bring you three ounces you say hey where’s the manager

What is this thing on my plate but you could have a bigger steak once a week right if you can say three up three ounces a day and you get 21 ounce steak on the weekend that’s right but that means the rest of the week yeah no steak yes sure all right thanks very much dr. kopetsky for being with us we’ve been talking about aspirin and aspirin a day to prevent heart

Attacks and strokes we’ve got the lowdown doctor kopetski thanks thank you tom

Transcribed from video
Does aspirin help prevent stroke and heart attacks? – Mayo Clinic Radio By Mayo Clinic