💊 ASPIRIN, APOB & HEART ATTACK PREVENTION Aspirin is often talked about like it is either a miracle longevity drug or completely useless. The truth is more nuanced. Aspirin reduces platelet activation, which can lower the chance that a ruptured plaque suddenly turns into a heart attack or ischemic stroke. That benefit is very clear in people who already have cardiovascular disease. For primary prevention, however, studies such as ASPREE, ASCEND and ARRIVE showed that aspirin can reduce some cardiovascular events, but the benefit may be offset by increased major bleeding. That is why we no longer recommend aspirin automatically to every healthy person. President Trump is an interesting example. He has publicly reported taking daily aspirin for years, but it is important to understand that aspirin is NOT his only cardiovascular prevention strategy. His publicly released medical information also shows treatment with rosuvastatin + ezetimibe for cholesterol reduction. That distinction matters. Rosuvastatin + ezetimibe: ⬇️ LDL/ApoB-containing particles ⬇️ plaque formation and progression Aspirin: ⬇️ platelet aggregation ⬇️ chance of an arterial clot after plaque disruption In other words: Lipid lowering attacks the disease upstream. Aspirin reduces one of its dangerous downstream consequences. This is also relevant for bodybuilders. Anabolic steroid use may increase cardiovascular risk through higher blood pressure, adverse lipids/ApoB, cardiac remodeling and potentially increased thrombotic risk. But taking aspirin does NOT make elevated ApoB or steroid-associated cardiovascular risk disappear. For someone trying to prevent a heart attack, the priorities remain: Control ApoB, blood pressure, smoking, diabetes, body composition, sleep apnea and overall cardiovascular risk. Then aspirin becomes an individualized discussion based on cardiovascular risk versus bleeding risk. The goal shouldn’t simply be to make the blood harder to clot. The goal should be to prevent the plaque from developing in the first place.