$Unique_ID{BRK01881} $Pretitle{} $Title{Aspirin: Who Should Take it for Heart Disease Prevention?} $Subject{Aspirin Heart Disease diseases prevent Prevention preventions attack attacks stroke strokes platelet platelets blood clot clots clotting formation formations artery arteries damage muscle muscles tissue tissues brain cell cells circulation transient ischemic TIAs atherosclerosis angina Physician's Health Study benefit benefits health healthy history dose dosage dosages contraindication contraindications bleed bleeding disorder disorders pressure pressures peptic ulcer ulcers bruise bruises bruising intolerant intolerance sensitive sensitivity gout kidney medication medications prescription prescriptions nonsteroidal anti-inflammatory drug drugs NSAIDs anticoagulant Food Drug Administration FDA heart-attack heart-attacks} $Volume{} $Log{ Atherosclerosis of Arteries*0009301.scf Complications of Atherosclerosis*0009401.scf Risk Factors of Atherosclerosis*0009302.scf The Heart's Blood Supply*0008901.scf} Copyright (c) 1993 Tribune Media Services, Inc. Aspirin: Who Should Take it for Heart Disease Prevention? ------------------------------------------------------------------------------ QUESTION: My friend keeps bragging that by taking his daily aspirin, he is taking a necessary step to prevent a heart attack. The way he talks, every one should do the same, and I am wondering if you advise this. I would be very grateful for this information, as would many of your other readers. ------------------------------------------------------------------------------ ANSWER: To be totally correct, my answer to your question is "Yes, I do recommend an aspirin to prevent heart attacks, SOMETIMES!" However, when I do, it follows a very careful history and examination, and only in cases where a number of other factors have been considered. The history of the use of aspirin is an interesting one, for there have been quite a few large clinical trials to establish the usefulness of aspirin in the treatment and prevention of both heart attacks and strokes. Aspirin works on the platelets that circulate in the blood and reduces their ability to clump together, one of the steps in clot formation. By reducing the ability of the blood to clot, aspirin can help reduce the possibility that vital arteries will become obstructed, and that prevents the damage to heart muscle tissue and brain cells that occurs when circulation is cut off. There are a number of situations in which the patient has already experienced difficulty that aspirin is indicated to prevent a recurrence of the problem, for example after a heart attack, or transient ischemic attacks (TIAs). It is also used in individuals with proven atherosclerosis or unstable angina. Recently the Physician's Health Study, in which 22,000 physicians participated as the test population, produced data which indicated that aspirin may be of significant benefit in healthy adults who have no previous related history. The aspirin dosage used in this study was a 325 mg tablet every other day. However, a similar trial conducted in England for 6 years using 500 mg of aspirin failed to show the same benefits. That leaves the question of appropriate dosage a bit in the air, for perhaps the British dosage was too high to obtain any benefits. There are quite a few contraindications to using aspirin in this way. Any history of bleeding disorders, uncontrolled high blood pressure, recent peptic ulcer disease, tendency to bruise easily, intolerance or sensitivity to aspirin would remove the patient from my list of people who can use this therapy. I would also be most careful in treating people with gout or some kidney problems, and would have to balance out the risks when the patient is taking other medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulant medications. Having considered all of the above, and providing I could find no other reasons that would influence my decision, my choice probably would be for a 325 mg enteric coated tablet, on a one tablet per day schedule. A daily dose would avoid the confusion that could occur when trying to maintain an every other day schedule. This said, let me stress that using aspirin in this fashion is not to be undertaken without consultation with your own physician. It is serious medicine, and a patient on this therapy should be closely followed. There is no general consensus on this question by the medical community, nor has the Food and Drug Administration approved aspirin for this use. And using this therapy does not remove the obligation of both patient and physician to help reduce the possibility of both heart attack and stroke by reducing all other risk factors, such as weight reduction and cessation of smoking. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.