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I recently went to the doctor for a checkup. Because my family has a strong history of heart disease, the doctor ran some additional tests. The only test that came back abnormal revealed that I had high levels (4.9) of C-reactive protein. The doctor told me I should start taking aspirin daily to reduce my risk of heart attack. I'm only 27 years old and I have normal cholesterol, blood pressure, and weight. Isn't daily aspirin a little drastic? Should I be concerned about serious heart problems?
— Heartily Concerned
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First, I think it is great that due to your family history and you went and got a checkup. Heart disease, in the form of coronary artery disease (i.e. heart attacks), is the leading cause of adult mortality in the United States. There are multiple known risk factors for developing heart disease including: age, sex (men more than women), high blood pressure, high cholesterol, smoking, diabetes, and family history. The C-reactive protein test that you mentioned is a nonspecific test, but has been associated with higher incidences of heart disease in a limited number of studies. Its role in treating patients has not been defined. Given that you have normal blood pressure, weight, and cholesterol, the most important risk factors to discuss in your case are age and family history (assuming you don’t smoke). It would be exceedingly rare to suffer a heart attack at an age less than 40. Unless you have a female relative, i.e. sister or mother, who has had a heart attack before they turned 40 then your chances are close to zero.
Aspirin has been shown to reduce the incidence of heart attacks. It is generally used based on a person’s 10-year risk of having a heart attack. This can be calculated easily by using the Framingham Risk Score, which is based on a large-scale study of heart-attack risk. Assuming what you told me is accurate, your calculated risk would be less than 1 percent risk of having a heart attack in the next 10 years. Doctors generally recommend aspirin for anyone with greater than 6 percent risk over 10 years. This risk score does not account for family history, but your family history would have to be very strong to alter the risk. Also remember that men generally have heart disease at a younger age than women. So if your father had a heart attack at 40, you are unlikely to be at risk until later in your 40s or 50s. I think it is always a good idea to get a second opinion if you are unsure about your doctor's advice. In the meantime, the most important things you can do to avoid heart attacks in include regular exercise, a heart-healthy diet, avoiding cigarettes, and regular checkups to makes sure you have normal blood pressure and cholesterol.
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