Trump's aspirin disclosure brings new attention to drug's benefits, risks

President Donald Trump's disclosure that he takes a large daily dose of aspirin to prevent the onset of cardiac disease, despite his doctor's recommendation he take less, has brought new public attention to one of the most widely used and best known medications in the world.

Aspirin, available since the 1900s, helps prevent blood clots, which can reduce the risk of heart attacks and some strokes. As many as 29 million Americans take it regularly in low doses as a prophylactic against cardiovascular disease, including millions who do so without a doctor’s recommendation, according to one study.

But regular aspirin use can cause life-threatening gastrointestinal bleeding, especially for people who are over 60 or have other risk factors, such as a history of stomach ulcers. Experts say that serious risk needs to be weighed against any of aspirin’s potential benefits, especially for people without cardiovascular disease.

"The benefits that we were hoping to get for decreasing [blood vessel clotting] are outweighed by the risks of taking this medication, especially in older adults," Dr. Marzena Gieniusz, a geriatrician with Northwell Health’s Division of Geriatrics and Palliative Medicine, said in a phone interview. Even for occasional use as a pain reliever or fever reducer, "we don’t use aspirin as often — there are things like Tylenol that are considered safer and as effective, if not more effective."

In 2022, an influential panel of independent medical experts, the U.S. Preventive Services Task Force, recommended that people who are 60 or older should not start taking aspirin to prevent a first heart attack or stroke after finding "no net benefit" to taking the medicine. The panel found a small primary prevention benefit for low-dose aspirin for adults 40-59 with elevated risk for cardiovascular disease but said it should be an individual decision for those people.

Other groups, among them the American College of Cardiology, noted after that finding that they still recommended low-dose aspirin for patients with existing heart problems, including a history of heart attack or stroke.

But the ACC advice was qualified: It said a low dose, or 75-100 milligrams, of aspirin "might be considered" for high-risk adults who are not at increased bleeding risk. It said that aspirin should not be considered on a routine basis for adults older than 70 for prevention of cardiovascular disease and should never be administered for primary prevention for adults of any age who are at increased risk of bleeding.

The president’s daily aspirin intake — 325 milligrams, according to The Wall Street Journal — is considerably more than the doses considered by those expert groups. The article said Trump blamed his large daily dose for causing him to bruise easily but that he declined to alter a protocol he felt has served him well over the last 25 years, calling himself "a little superstitious" about such matters.

Gieniusz said that evidence shows "no additional benefit of having the higher dose that outweighs the increased risk with taking the higher dose."

She said it was "very possible" that Trump’s aspirin intake contributed to his bruising, but said that in general, "as we get older, our risk for bleeding and bruising increases. Our blood vessels are more fragile, our skin is much thinner, and there is increased risk of injury to blood vessels."

People who might once have turned to aspirin to head off a heart attack should consider simple lifestyle changes, she said.

"We often recommend low salt, or limited salt intake. Controlling blood pressure is very important, controlling blood sugar, limiting stress. Good quality and amount of sleep" is also important, she said. "We often forget how these basic lifestyle things affect our health, even down to our blood vessels."

By Nicholas Spangler

nicholas.spangler@newsday.comspanglernewsday

Nicholas Spangler is a general assignment reporter and has worked at Newsday since 2010.