Aspirin May Prevent Clots That Cause Stroke, Heart Attack
“An apple a day keeps the doctor away.” For millions of Americans, the same statement can be made for aspirin--and with more scientific evidence to back up the claim.
Almost everyone has used aspirin--formally known as acetylsalicylic acid--at one time or another to reduce fever, relieve pain or control inflammation. But this ages-old medicine can also interfere with the formation of blood clots, thereby reducing--for some people--the risk of heart attacks and strokes.
Interfering with blood clotting may sound strange, since clots help keep you from bleeding too much when you scrape your skin or suffer a serious injury. But clots can also cause serious problems in the body--for example, when they become lodged in the arteries that supply blood to the heart and the brain. In fact, blood clots in these vital locations are responsible for the vast majority of heart attacks and strokes.
*
Research shows that both men and women with a history of cardiovascular disease may benefit from the regular use of aspirin. In one large study, those who routinely took aspirin reduced their risk of stroke or heart attack by about 25%.
The American Heart Assn. recommends 75 milligrams to 325 milligrams of aspirin a day for men and women known to have cardiovascular disease. This includes those who have suffered a stroke caused by a blood clot to the brain; a heart attack; a transient ischemic attack (or “mini-stroke); or angina (chest pain) that is worsening or is occurring at rest or with minimal exertion.
There is one additional group of individuals who might benefit from taking aspirin: men and women who are actually having a heart attack. If taken immediately, aspirin can reduce by 23% the likelihood of dying after a heart attack. The American Heart Assn. recommends giving one regular-strength aspirin to anyone who is experiencing a heart attack as soon as the symptoms are recognized and emergency help has been contacted. If the aspirin has a coating designed to prevent it from being dissolved in the stomach, the pill should be crushed or chewed to speed its absorption.
It isn’t yet clear whether people without a history of cardiovascular disease should take aspirin daily. In one study of people without cardiovascular disease, men who took aspirin every other day were 44% less likely to suffer a heart attack than men who did not. However, both groups were equally likely to die of cardiovascular disease. Another study found no significant difference between individuals taking aspirin daily and those taking a placebo.
*
Until further studies are done in low-risk individuals, the American Heart Assn. recommends that the decision to use aspirin be made by the patient and physician on an individual basis. For men and women at high risk of suffering a heart attack or stroke, the potential benefit of aspirin therapy may outweigh any potential harm. In low-risk individuals, however, the reverse might be true.
Like all medications, aspirin can cause adverse side effects, including stomach pain, heartburn, nausea and constipation. More serious complications include stomach ulcers and bleeding (particularly in the gastrointestinal tract and brain). The risk of side effects can be minimized by reducing the dosage. Low doses--75 milligrams to 325 milligrams per day--appear to be as effective as higher doses in the prevention of heart attacks and stroke, and rarely cause serious side effects.
Still, some people find side effects intolerable even at low doses, and others have medical conditions that make the risk of serious side effects too great. Aspirin therapy is not generally recommended for individuals who are allergic to acetylsalicylic acid and for people who have high blood pressure, liver or kidney disease, peptic ulcers or bleeding problems. For individuals who cannot take aspirin, other medications that prevent normal clotting can sometimes be used.
If you think you are a potential candidate for aspirin therapy, talk to your doctor about the benefits and risks. Because there are real risks associated with the regular use of aspirin, it should be taken only under the close supervision of a physician.
*
Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at ourhealth@dhs.co.la.ca.us. Their column appears on the second and fourth Mondays of the month.
