Should Runners Take Aspirin Before a Marathon?

Q I read an article in the New York Daily News that said every runner should take aspirin. I have never taken it before and have no history of cardiovascular disease. I am 52, in good health, and planning to run the New York Marathon. My doctor also said there was no evidence to support use for healthy runner like me. Now the news article says my doctor is wrong. What do you think?


A My advice, as always, is to listen to your physician who you know and trust, and not to blindly follow the suggestions from newspaper articles or blogs written by people you do not know and who do not know you. That includes me.

A friend sent me the article from the New York Daily News that you are referring to and I do not I agree with the author’s recommendations regarding aspirin use for prevention of heart attack in runners. The science is not there yet, and may not ever be to make a blanket recommendation for all runners to take aspirin. Sudden cardiac death during marathons is a relatively low risk problem affecting very few marathon runners each year.

I re-read the article referenced and the research work supporting the use of aspirin prior to the marathon. It is essentially an opinion article extrapolating work on primary and secondary prevention of heart attack in higher risk non-runners to a low risk group of runners. It is not a research-based article comparing outcomes of runners who use aspirin pre-race to those who do not.

While there is a place for daily aspirin use for runners with prior history of heart disease or diabetes (secondary prevention) and in runners with risk factors for heart attack that would potentially improve the outcome of a cardiac event (primary prevention), both should be under the direction of a personal physician. The call to use race day aspirin in all marathon runners, most who are at low risk for a cardiac event, has potential to do more harm than good. If you have worries about heart attack because of family history, medical problems, or lifestyle issues, you should speak with your physician about training, racing, and heart disease before race day. While opinion-based recommendations outlined in the New York Daily News have a place in medicine, it does not seem prudent to recommend aspirin for all low risk marathon runners.

– Bill

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