Aspirin, Wonder Drug for the Heart?

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(Author By Bethanne Black) If you’re like most people, you’ve taken aspirin to ease an occasional headache or to soothe muscle aches and pains. But what many Americans don’t realize is that aspirin can help prevent a heart attack.

“Despite its proven health benefits, studies show that aspirin is underused by many people who have experienced a heart attack,” explains Randall Stafford, MD, PhD, assistant professor of medicine at Harvard Medical School.

Up to 10,000 more people would survive heart attacks if they took one aspirin tablet (325 milligrams) when they experienced chest pains or other signs of a heart attack, according to the American Heart Association (AHA). Studies show that 60 to 80 percent of heart-attack patients take aspirin for their condition.

How Aspirin Works

The origin of aspirin can be traced to Hippocrates, the Greek physician traditionally regarded as the “father of medicine.” He told followers to chew on the leaves of willow trees in order to reduce pain, which contained a substance known as salicin. Salicin is part of a larger class of drugs called salicylates, the most popular being aspirin.

Physicians don’t fully understand how, but aspirin seems to improve blood flow in the heart’s arteries during a heart attack. In an attack, coronary arteries become clogged with plaque and debris. Aspirin helps by preventing blood platelets from forming blood clots; by blocking blood vessels, clots can cause heart attack and stroke.

Experts agree that aspirin achieves some of its effects by inhibiting the production of prostaglandins. Prostaglandins are hormone-like substances that influence the elasticity of blood vessels, direct the functioning of blood platelets that help stop bleeding, and regulate other bodily activities.

With so many pain relievers on the market, it’s easy to become confused about which products are truly aspirin. Aspirin is most often sold as Bayer, Bufferin, or other “generic” names. Other pain relievers and fever-reducing drugs, such as acetaminophen, ibuprofen, naproxyn sodium, and ketoprofen, have not been shown to have aspirin’s beneficial impact on cardiovascular health, according to the U.S. Food and Drug Administration (FDA).

Primary and secondary prevention

Using aspirin to prevent a first heart attack, stroke or other vascular condition in otherwise healthy men and women is referred to as “primary prevention,” according to the AHA. Conversely, taking aspirin after the onset of a known heart or blood vessel disease is known as “secondary prevention.”

The AHA and cardiac experts agree that aspirin can help people who have already had a heart attack (secondary prevention). However, they disagree on whether it can actually prevent heart disease (primary prevention). If a person does not have a bleeding disorder or aspirin allergy, the AHA recommends the use of aspirin for those who have experienced:

  • Myocardial infarction (heart attack)
  • Unstable angina (chest pain)
  • Ischemic stroke
  • Transient ischemic attacks (TIAs, also known as “little strokes”)

This recommendation is based on strong evidence showing that aspirin prevents the recurrence of these health conditions. However, according to the AHA, clinical trial evidence isn’t available to demonstrate similar benefits in patients with other forms of diagnosed vascular disease, such as:

  • Peripheral vascular blockage
  • Carotid artery narrowing
  • Aortic atherosclerosis

When considering aspirin use, physicians must evaluate each patient individually. In particular, they should weigh a person’s risk of heart attack and coronary heart disease and death against the potential for adverse reactions to prolonged aspirin therapy.

“In my view, doctors should weigh the risk profile of the patient, the side effects of the drug, and the clear benefit of aspirin in reducing the risk of a first heart attack by about 33 percent,” says Charles Hennekens, MD, visiting professor of medicine, epidemiology, and public health at the University of Miami School of Medicine.

Aspirin use has risks

The same quality that gives aspirin its potential benefit — its ability to inhibit clotting of the blood — may increase the risk of excessive bleeding, including the possibility of bleeding in the brain, according to the FDA.

What’s more, if you are allergic to a non-steroidal anti-inflammatory medications (NSAIDs), such as Advil, you may also be allergic to aspirin. It’s best to tell your doctor about any and all drug allergies prior to taking aspirin.

Experts also say that if certain medical conditions or situations apply to you, it’s important that you talk to your healthcare provider before taking aspirin. These include:

  • liver or kidney disease
  • peptic ulcer
  • gastrointestinal disease or bleeding
  • other bleeding problems
  • allergy to aspirin
  • alcohol use

Furthermore, studies show that there are other risks associated with frequent aspirin use, says cardiologist Stephen T. Sinatra, MD, assistant clinical professor of medicine at the University of Connecticut School of Medicine.

“In women over the age of 75, aspirin can increase the risk of stroke,” he says. However, studies show that the same risk is not as prevalent in men. Although some cardiac specialists maintain that aspirin therapy should begin at a certain age, it’s best to follow your doctor’s advice, since most individuals have unique health concerns.

The future of aspirin

Better understanding of aspirin’s numerous effects in the body has led to clinical trials and other studies to assess a wide variety of possible uses. However, some disagreement still exists among physicians about the exact role that aspirin plays in maintaining heart health.

Fortunately, experts agree on one important point: Aspirin should never be a substitute for medical or emergency care. With or without aspirin, heart attack symptoms are always an emergency. If you have symptoms, you should seek medical care immediately.

Still confused about the bottom line on aspirin use? “As with all other medications, patients should discuss aspirin therapy with their physician before taking it on their own,” recommends Stafford.

Sources:
American Heart Association
National Library of Medicine Archives
U.S. Food and Drug Administration

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