Heart Doctors Warn About Higher-Dose Daily Meds After President Calls His 325-Mg Habit a ‘Monster’

A factory speech took a detour into medicine. At an event in Vandalia, Ohio, President Donald Trump drifted from congratulating Bayer on a new plant into a monologue about his daily aspirin. He told the crowd he is not sure it works, but needs it psychologically. Doctors interviewed by HuffPost used the moment to explain what research now says about taking aspirin every day.

Trump described the pill he takes as “a monster.” He said doctors want him on a lower dose, and that he has taken the larger one for 35 years. His physician, Dr. Sean Barbabella, told The Wall Street Journal in January that the dose is actually 325 milligrams, taken daily for “cardiac prevention.” Trump told the paper he is a bit superstitious and does not want thick blood reaching his heart.

Trump said “386” in the speech, but his physician has confirmed 325 milligrams. The gap matters less than the larger question the comments raised: does a daily aspirin help, and at what dose? Doctors say the answers have changed in recent years. They also say the fundamentals are widely misunderstood, starting with what aspirin actually does inside the human body.

Aspirin Doesn’t Literally Thin Blood, and Guidance for Healthy Adults Has Tightened

Aspirin does not literally thin blood. It reduces the activity of platelets, the cell fragments that help blood clot. A clot is the first event in many heart attacks and strokes, which is why aspirin can protect some patients. Doctors split patients into two groups: those with diagnosed disease, who often need aspirin to keep it from progressing, and healthy people trying to prevent a first event.

Dr. Jonathan Reiner, a CNN medical analyst, put it plainly when Trump first discussed his aspirin in January: “It makes you less likely to clot.” The bigger shift is about who should take it. Dr. Gregory Katz of NYU Langone says several large trials published around 2018 did not show a benefit for most people without heart disease. Aspirin slightly lowers heart attack and stroke risk, he says, but slightly raises bleeding risk.

The U.S. Preventive Services Task Force updated its guidance in 2022. It recommends against starting aspirin to prevent a first heart attack or stroke in adults 60 and older. For adults 40 to 59 with a 10% or greater 10-year cardiovascular risk, it calls the choice individual. These rules address starting aspirin. Anyone already taking it should talk with a doctor before changing anything. Dose is the other half of the question.

The Standard Dose Is 81 Milligrams, and Higher Doses Raise Bleeding Risk Without Clear Benefit

Doctors interviewed by HuffPost were emphatic that more is not better. The standard daily dose for cardiology prevention, primary or secondary, is 81 milligrams. Dr. William Lawson of the Stony Brook Heart and Vascular Institute says U.S. studies show 81 milligrams works as well as 325 for everyday prevention. Higher doses are used briefly during an acute heart attack, angioplasty, or stenting, then followed by a lower maintenance dose.

The risk of higher doses is bleeding. Lawson says a higher dose increases bleeding events, and Dr. Robert Brook of Wayne State University says doses above 81 milligrams are not warranted because they raise risks more than benefits. He called it “settled medical science and clinical practice.” Bleeding can mean stomach inflammation, ulcers, gastrointestinal bleeding, or bleeding in the brain, and the risk climbs with age.

Brook describes a frustrating catch-22. The people who stand to benefit most from heart protection are often the ones at highest risk of bleeding, so preventive aspirin is individualized. Reasons to avoid it include recent surgery, a recent brain bleed, ulcers, allergies, and certain cases of asthma. Blood thinners such as Eliquis, Xarelto, and Coumadin can compound the bleeding risk. All of that leaves one question the doctors cannot answer: the president’s own situation.

Doctors Won’t Judge the President’s Care, but One Says 325 Milligrams Exceeds the Recommended Dose

Several experts declined to judge Trump’s treatment without his medical history. One was more direct. Lawson said 325 milligrams exceeds the recommended 81-milligram dose for patients with established coronary artery disease and may contribute to the bruising sometimes seen on the president’s limbs. The White House has attributed bruising on his hands to frequent handshaking combined with his aspirin.

The other experts stressed what they could not see. Dr. Amit Blumfield, a cardiologist, said that if the president has a reason for secondary-prevention aspirin, he should take it, as long as risks and benefits have been discussed with his physicians. Katz agreed that judging care is impossible from outside. “Every single patient is different,” he said. The answer depends on history, tests, and family background that the public does not have.

The most useful lesson here has little to do with the president. The doctors’ advice applies to anyone who takes a daily pill: do not start or stop on your own, and know why it was prescribed. Know the side effects, the risk of stopping suddenly, and what it interacts with. Every daily medication has a reason behind it. The safest patient is the one who can say what it is.

This article is general information, not medical advice; do not start or stop aspirin without talking to your doctor.