Can I take Aspirin Before a Marathon?

A recent article in the New York Daily News recommends aspirin use for prevention of heart attacks in runners. The science is not there yet, and may not ever be to make a blanket recommendation for all runners to take aspirin (for example, there's research that actually disputes the benefits of aspirin for athletes).

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Just to put this problem into perspective, there are just under 1 million deaths from cardiovascular disease in the United States each year, and 4 to 6 of those deaths occur in runners during marathons (there are roughly half a million marathon finishers each year in the United States). So sudden cardiac death during marathons is a relatively low-risk problem affecting very few marathon runners each year.

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 don't know and who don't know you. This includes me.

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I re-read the article referenced as the research work supporting the use of aspirin prior to the marathon. It's essentially an opinion article extrapolating work on primary and secondary prevention of heart attacks in higher risk non-runners to a low-risk group of runners.

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It's not a research-based article comparing outcomes of runners who use aspirin pre-race to those who do not. (For practical nutrition tips you can use, read these Pre-race and Mid-race Fueling Rules.)

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While there's 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.

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If you have concerns about heart attacks 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.

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