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Can 1110 Aspirin Users Be Wrong? Yes!

Dr. Levi

Take an aspirin a day to prevent a heart attack is an often presented wisdom that few actually think about. So what are the numbers behind this sage advice? Who lives?  Who dies? Who thinks it works but doesn’t? Who get’s the stroke or ulcer? Who benefits from every person over 45 being on an aspirin?

In an article titled   “Does aspirin cut deaths? New study clouds picture” the authors review some aspirin statistics that every user should know. 1,111 people would have to take an aspirin a day for 4 -10 years to prevent 1 death. It’s called the Number Needed to Treat, or NNT.

Do you get that?  1,110 people who take an aspirin a day, in order to save their life, are not benefiting. But they are exposed to risks. It’s a numbers game, except most people don’t win. Here’s the catch though, every living person who is on the medical regimen thinks they are “the one” who’s benefiting. Why not? They are alive. They were told they would be dead. It must be the drugs.

If all of them say “thank God for this aspirin, or I’d be dead by now”, only one of the 1,111 would be potentially correct.

Out of that 1,111 , nine of those individuals would suffer bleeding ulcers due to the drug, and nearly four would have other major bleeds, like hemorrhagic stroke.

Ironically, “for women age 55 to 79, aspirin is recommended to prevent strokes, with the same caveat.”

The article also states, “The U.S. Preventive Services Task Force (USPSTF), a federally supported expert panel, advises that men age 45 to 79 take aspirin to stave off heart attacks, as long as the benefit outweighs the risk of bleeding.”

I wonder how your medical doctor  or the American Heart Association can determine who will be whom?

While healthy people taking aspirin for prevention is hotly debated in the medical community, the benefits for people who have already had a heart attack is not debated. It’s unanimous. They benefit. But how much?

The likelihood of someone who has had a heart attack and surviving for 5 more years is 95%. If they take a baby aspirin a day then that statistical likelihood moves to 97.5%. Doesn’t sound very impressive if you put it that way. But if you reframe it, that is a 2.5 % reduction off of a 5% absolute chance of of dying for that subset of conditions. Now you can say that taking an aspirin a day can cut your risk of dying by 50%. That sounds much more impressive.

The question for me is not “how do I medically manage miniscule risk reductions of dying” but “How do I live, for what, for who, and why”.  None of those answers involve aspirin.

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