President Trump takes a high daily dose of aspirin, and has done so for over two decades, rejecting medical guidelines and advice from his doctors to switch to a lower amount.
“They say aspirin is good for thinning out the blood, and I don’t want thick blood pouring through my heart,” Mr. Trump told The Wall Street Journal in an interview.
The president, 79, was diagnosed this year with chronic venous insufficiency, a condition that occurs when veins have trouble moving blood back to the heart. He also showed signs of bruising on his hand, which his physician attributed to frequent handshaking and to the use of aspirin as part of his heart-health regimen.
A decade ago, the best evidence available suggested that the routine use of aspirin could reduce heart attacks and strokes in people without a history of heart disease by helping to prevent the formation of blood clots. But three large, randomized trials published in 2018 upended that thinking, suggesting that aspirin may not provide as much benefit in people without a history of heart disease and showing that it actually increased the risk of dying from bleeding and from cancer, particularly gastrointestinal cancers.
“We’ve really changed how we think of and how we recommend aspirin,” said Dr. Alex Krist, a family physician at Virginia Commonwealth University and Inova Health System. Dr. Krist, who has practiced and taught preventive medicine since 2002, worked on updating the aspirin recommendation in 2022 for the U.S. Preventive Services Task Force, which determines what preventive health measures insurance companies should cover.
Who should take aspirin daily?
Medical guidelines from groups like the preventive task force, the American College of Cardiology and the American Heart Association recommend against routinely using aspirin for the prevention of cardiovascular disease in older people (above ages 60 or 70, depending on the guideline) who have not previously had a heart attack or stroke.
The only people who are categorically recommended to take aspirin every day are those who have a history of cardiovascular disease, meaning they’ve previously had a heart attack, ischemic (nonbleeding) stroke or peripheral artery disease, a condition in which narrowed arteries reduce blood flow to the arms or legs, said Dr. John Mafi, a primary care physician at the University of California, Los Angeles. This is because the risk-to-benefit ratio is in favor of taking aspirin in this group, he added.
A memo released by the White House last month said Mr. Trump’s cardiovascular imaging was “perfectly normal.” Reports on his health have not indicated any history of heart attack or stroke. One previous scan did indicate plaque was present in his arteries, which is not uncommon for men his age.
The standard daily dose of aspirin for those taking it to prevent a second heart attack or stroke is a low-dose, or “baby” aspirin, 81 milligrams, Dr. Mafi said.
Mr. Trump is taking about four times as much of that amount, or 325 milligrams, according to The Journal.
Aspirin may be considered in those under 60 or 70 years old who are at increased risk of heart attack, but patients and doctors should make a decision based on an individual assessment of risks and benefits, according to guidelines.
Risk factors for heart disease include high cholesterol, high blood pressure, diabetes, and a history of smoking. A strong family history of heart attack or stroke at a younger age might also tip the scale in favor of recommending aspirin to a patient, Dr. Krist said.
What are the risks and benefits of taking aspirin daily?
Aspirin works by inhibiting the action of platelets, cell fragments that stick together to form clots and stop or prevent bleeding, Dr. Mafi said. Clots are a culprit of heart attacks and ischemic strokes.
But it’s that same anti-clotting effect that causes aspirin to increase the risk of bleeding — a risk that also increases with age. Doctors worry most about rapid internal bleeding that can be fatal — for example, gastrointestinal bleeding or a sudden brain hemorrhage. The absolute risk of such events is low, according to the latest preventive services task force recommendation, but it increases with age, and particularly in adults over 60.
Some research has suggested that aspirin can help prevent colorectal cancer, but the evidence is insufficient to recommend it solely for that purpose, Dr. Mafi said.
Can you take too much?
A trial of 15,000 people with a history of cardiovascular disease who were randomly assigned to take 81 or 325 milligrams daily found no incremental benefit from the larger dose, and some studies have shown higher doses were associated with greater harms.
“Your bleeding risk does go up with higher doses without an additional benefit of reducing heart attack or stroke,” Dr. Krist said.
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