President Donald Trump recently described his daily aspirin regimen, stating he takes a "monster" dose of Bayer aspirin, specifically the 325-milligram version, which he attributes to psychological need and a long-standing habit. He mentioned his physician, Dr. Sean Barbabella, confirmed the daily use for "cardiac prevention" but noted Trump's preference for the higher dose over the more commonly recommended 81-milligram strength.
Trump's comments came during an event in Vandalia, Ohio, and preceded his remarks congratulating Bayer on its new manufacturing plant planned near Columbus. He previously told The Wall Street Journal that he is "a little superstitious" about his aspirin use, wanting "nice, thin blood" rather than "thick blood pouring through my heart."
Medical professionals, however, clarify that aspirin does not literally thin the blood; rather, it decreases platelet function and reduces the likelihood of clot formation, which is a key factor in heart attacks and strokes. Dr. Jonathan Reiner explained on CNN that aspirin makes one "less likely to clot," not that it changes blood viscosity.
Shifting Guidance on Daily Aspirin
Experts note that recommendations for daily aspirin have evolved significantly in recent years. Dr. Gregory Katz, a cardiologist at NYU Langone Heart, stated that major clinical trials around 2018 indicated aspirin offers little benefit for most individuals who have not experienced a heart attack or stroke. While aspirin can slightly lower the risk of heart attack and stroke, it also carries an increased risk of bleeding complications.
Dr. Amit Blumfield, a cardiologist with Manhattan Cardiology, distinguishes between primary and secondary prevention. Low-dose aspirin (81 mg daily) is considered essential for secondary prevention, meaning it's used to prevent the progression of an already diagnosed cardiovascular disease like coronary artery disease or peripheral artery disease, or after a prior stroke. For primary prevention, meaning in individuals without these conditions, the use of aspirin is more debated.
Low-dose aspirin is often prescribed for patients with established cardiovascular issues such as coronary artery disease, prior heart attack, or following stent placement or bypass surgery. It may also be prescribed for younger patients, aged 40-59, who are at high risk of a cardiovascular event. However, for individuals without heart disease, recent trials have shown that the risks, including gastrointestinal bleeds and intracranial hemorrhage, can be roughly equal to the modest benefits of reducing a first heart attack. The U.S. Preventive Services Task Force updated its guidance in 2022, no longer recommending aspirin for primary prevention in individuals over 60. Adults aged 40-59 may consider low-dose aspirin for primary prevention if their 10-year cardiovascular disease risk score is high, but this recommendation remains a subject of discussion.
Risks and Dosages
The primary risks associated with daily aspirin therapy are related to bleeding, including stomach inflammation, ulcers, gastrointestinal bleeding, and bleeding in the brain. These risks can increase with age, potentially outweighing the cardiovascular benefits for some individuals. The risk of bleeding is compounded for those also taking blood thinners like Eliquis, Xarelto, or Coumadin.
Experts emphasize that higher doses of aspirin, such as the 325 mg Trump reportedly takes, do not offer improved cardiovascular outcomes compared to the standard 81 mg dose. Instead, higher doses increase the risk of bleeding events. Dr. William Lawson noted that studies show 81 mg of aspirin has the same chronic efficacy as a 325 mg dose for everyday cardiovascular disease prevention, while higher doses increase bleeding risks without added benefit. Doses above 81 mg are generally not warranted for prevention and can substantially increase risks, according to medical consensus.
Lawson suggested that Trump's 325 mg daily habit might contribute to bruising, which the president and his team have previously attributed to frequent handshaking along with his aspirin regimen.
While Trump's specific medical history and the reasons for his prescribed dosage are not public, medical professionals stress the importance of individualized care. They advise against starting or stopping daily aspirin without consulting a physician, as the decision involves a complex assessment of potential harms versus benefits based on a patient's unique health profile, cardiovascular risk, and other medical conditions. For individuals with established heart disease, discontinuing aspirin without medical advice can be particularly risky.