Does a 33-year-old in good health need a daily aspirin?

June 7, 2007 8:37 AM

Do I need a second medical opinion regarding an aspirin regimen? I can't figure out if this is minor or something I should look into.

My new Primary Care Physician recommended that I start a low-dose (81 mg) aspirin regimen. This was based on a family history of heart disease (both my Paternal grandfather and paternal uncle died of heart attacks in their early 50's, my dad had a heart attack at 50 but is still here and hasn't had another).

But here's the rub- I'm 33 and a vegetarian, with normal cholesterol and really low triglyceride levels. Blood pressure is normal. I generally run 15-20 miles a week (doing more at the moment, see below), do some weight work and don't smoke. I am 10-15 pounds overweight currently, but I'll be at fighting weight in a month or so (I weighed 205 at 6'2" at the visit over a week ago and immediately cut back on food intake and added some miles).

The reputable-seeming aspirin therapy sites are cagey about age, and seem to be more about people with pre-existing heart problems. What really bugs me is that some of them mention GI problems, including bleeding, and I have IBS. I mentioned this to my doctor, and he barely seemed to hear me, said "don't worry about it" and moved on to telling me to take an Omega-3 fish oil supplement as well (which seems fine).

So do I need a second opinion about whether I should be taking aspirin, or should I just shut up and do it? If I get side effects from taking aspirin, are they just going to go away if I cease taking it, or am I potentially setting myself up for long term complications?

I know-- it's just aspirin. But I want to keep my current level of health as well as potentially stave off future problems.

posted by Mayor Curley to health & fitness (11 comments total)

My doc recommended the same thing for me, given my family history of stroke. I'm younger than you, run as much as you, with low cholesterol and blood pressure, not overweight at all, don't smoke. I don't think it's an unusual piece of advice.
posted by croutonsupafreak at 8:43 AM on June 7, 2007

From what my docs have told me, family history plays a huge part in your risk for heart disease, and low-dose aspirin seems to be a very common piece of advice. My personal opinion - try it, and if it doesn't cause you any problems, go with it. It may just save your life, or at least prevent a heart attack or stroke. If there are side effects, discuss them then with your doctor. My random data point: I (at 29), was put on low-dose aspirin due to a perceived high stroke risk. It occasionally gave me heartburn, but once my docs took me off the aspirin (for unrelated reasons) the heartburn went away completely.

If you're really concerned tho, just get a second opinion. At the very least, it'll put your mind at rest.
posted by cgg at 9:24 AM on June 7, 2007

An anecdote that may be helpful: My dad randomly put himself on an aspirin a day without consulting a doctor. He took it for a long while and ended up with GI issues (including bleeding).
He went to the doc and it turns out he wasn't taking buffered aspirin which was the problem. The doc started him on that and it's been years and he's fine. And all of the badness went away once he stopped the original aspirin.
posted by jdl at 9:33 AM on June 7, 2007

How about using enteric-coated aspirin?
posted by gramcracker at 10:29 AM on June 7, 2007

While aspirin is of proven benefit in many settings (acute heart attack, patients with prior heart attacks, diabetics, and others) its use to prevent a first heart attack in someone with few risk factors is less clearly beneficial. The side effects of aspirin are not insignificant, especially when taken daily and when the patient has an active lifestyle (running, weightlifting) that may predispose them to trauma that may be worsened by aspirin's blood-thinning effects. For all these reasons it would seem reasonable to get a second opinion or ask your current doc what his thoughts concerning your therapy. That is not to say you shouldn't take aspirin, but a discussion of the risks versus the benefits is reasonable.
posted by TedW at 10:35 AM on June 7, 2007

I say, get a second opinion. I don't like the fact that he did not seem to listen to you and did not explain why he doesn't agree with your concerns. There is exactly one person who is really interested in treating your health holistically, get all the information you can.
posted by shothotbot at 10:45 AM on June 7, 2007

You may find this interesting, but I am afraid I can only give you the abstract.

OBJECTIVE: Symptoms of irritable bowel syndrome (IBS) are reported by 10% of the general population; however, evaluation of traditional risk factors has not provided any insight into the pathogenesis of this condition. The objective of this study was to identify additional risk factors for irritable bowel syndrome. METHODS: A valid self-report questionnaire that records the gastrointestinal (GI) symptoms required for a diagnosis of IBS, self-reported measures of potential risk factors, and a psychosomatic symptom checklist was mailed to an age-and gender-stratified random sample of Olmsted County, Minnesota residents aged 30-64 yr. A logistic regression model that adjusted for age, gender, and psychosomatic symptom score was used to identify factors significantly associated with IBS. RESULTS: A total of 643 (72%) of 892 eligible subjects returned the survey. IBS symptoms were reported by 12% of the respondents. IBS was significantly associated with use of analgesics (acetaminophen, aspirin, or nonaspirin nonsteroidal antiinflammatory drugs) for reasons other than IBS, reporting a food allergy or sensitivity, and ratings of somatic symptoms. No association was detected for age, gender, body mass index, smoking history, alcohol use, educational level, exposure to pets in the household, or water supply. Among subjects reporting the use of just one type of analgesic, IBS was associated with acetaminophen but not aspirin or nonaspirin nonsteroidal antiinflammatory drugs used alone. The odds of having IBS were higher among subjects reporting more reasons for taking analgesics and intolerance to a higher number of foods. CONCLUSIONS: IBS is significantly associated with analgesic use. However, this is confounded by other somatic pain complaints. IBS symptoms are associated with the reporting of many food allergies or sensitivities. The role of food-induced symptoms in IBS requires further investigation. --"Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities."

It is just a survey though.
posted by 517 at 10:50 AM on June 7, 2007

As others have said, although you are out of the age range commonly associated with risk factors for heart disease, the family history is very important - some would say (& have told me) that family history is THE most important risk factor in assessing a person's risk - more than smoking status or other things.

I am not trained in this so I have no opinion one way or the other about whether this is the case or not. But that's my guess as to the reasoning behind your physician's prescription.

Also remember that baby aspirin (81 mg) is very different than regular aspirin (325 mg) and does tend to be better tolerated.
posted by mikel at 10:59 AM on June 7, 2007

Your question is about the use of aspirin in primary prevention. Primary prevention means someone who has never had an event of the type the intervention is meant to prevent. For example, you have never had a heart attack. For you, the use of aspirin to prevent a heart attack is therefore considered primary prevention.

Here's a recent review of the topic.
posted by ikkyu2 at 11:46 AM on June 7, 2007

Among the interesting findings of this study:

• all-cause mortality did not seem to differ among treated and untreated patients
• there was a tradeoff between heart attacks prevented versus GI bleeds and intracranial bleeds that would not otherwise have occurred
• whether the aspirin was enteric-coated, buffered, or low or high dose seemed to make no detectable difference
• Diabetic patients clearly did better with aspirin than without it
• Patients with controlled high blood pressure did better with aspirin, but patients with uncontrolled high blood pressure did not
• In general, the findings supported the idea that aspirin mitigated risk most in people who already had some elevated risk factors

posted by ikkyu2 at 11:53 AM on June 7, 2007

I think your IBS makes aspirin therapy questionable.

Here is a BBC account of a Spanish study which found that IBS is frequently the aftermath of a GI infection, and another here, of a Cambridge study which found that IBS is associated with activity of hydrogen producing bacteria in the gut.

The fever and inflammation which aspirin is so good at reducing are part of your defense against pathogens, and the GI bleeding associated with aspirin is particularly undesirable if hydrogen producers are involved, since iron is a big growth factor for at least some of them, so if your IBS is a result of pathogenic bacteria or other organisms, I think you run a significant risk of exacerbation by taking aspirin.
posted by jamjam at 12:30 PM on June 7, 2007