EP51: Aspirin: Good or Bad?

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary EP51: Aspirin: Good or Bad? Dr. Warwick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he addresses recent media headlines questioning aspirin's benefits by examining three major clinical trials—ASPRI, ARRIVE, and ASCEND—that collectively studied over 45,000 patients to clarify when aspirin is actually beneficial and when it isn't necessary. Key Takeaways: Recent headlines warning against aspirin are based on large, robust trials (ASPRI, ARRIVE, ASCEND) showing that healthy individuals and average-risk patients don't need aspirin for disease prevention. The ASPRI trial of 20,000 people over age 70 found that regular aspirin didn't improve quality of life, cardiovascular outcomes, or reduce dementia in healthy elderly individuals. The ARRIVE trial showed aspirin reduced heart attack risk in intermediate-risk patients but offered no significant benefit for stroke and came with increased bleeding risk. The ASCEND trial of over 15,000 asymptomatic diabetics over seven years showed aspirin was not compelling for primary prevention in this population. Aspirin remains strongly beneficial in secondary prevention—for patients who have already experienced a heart attack, stroke, stent placement, bypass surgery, or peripheral vascular disease. Dr. Bishop prescribes aspirin in primary prevention only for high-risk patients he has imaged and confirmed have significant plaque buildup in their coronary arteries. The key message is that aspirin decisions should never be based on headlines alone but require individualized conversations between patients and their doctors about specific risk-benefit ratios. Patients currently taking aspirin prescribed by their doctor should not stop without consulting their physician, as the recent trials don't apply to those with existing cardiovascular disease or high-risk imaging findings.