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HEART Insight:
doi: 10.1097/01.HEARTI.0000285621.92879.63
Features: Medicine Chest

Should Aspirin Be In Your Arsenal?

Palkhivala, Alison

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New Research Suggests Aspirin Is Good For What Ails The Cardiovascular System

Starting in his mid-40s, Stephen Cherlet started taking a low dose of aspirin every day. “I don't have heart disease, but my father died of a heart attack at 57. He had his first heat attack in his 30s.”

Given his family history, Cherlet asked his doctor whether it would be a good idea for him to take aspirin. His doctor thought it would. Cherlet, now 49, was recently given a cholesterol-lowering drug as well, based on his latest lab tests.

Cherlet is one of millions of Americans taking an aspirin a day for heart health. A 2003 telephone survey by Umed Ajani, M.B.B.S., M.P.H., a scientist with the Centers for Disease Control and Prevention (CDC) in Atlanta, found that 83 percent of people with cardiovascular disease and 63 percent of people with diabetes reported taking an aspirin daily. Most said they did so specifically because they thought it was good for the heart.

Dr. Ajani thinks many people turned to aspirin after learning about its benefits from media reports of research findings, and from recommendations by health and medical associations.

Researchers first began noticing aspirin's positive effects on cardiovascular health in 1988. A study involving over 17,000 patients who got to the hospital within 24 hours of having a heart attack suggested aspirin could reduce heart damage when taken early on. In this study, patients received the blood clot-busting drug streptokinase, aspirin, both drugs, or a dummy pill (placebo). Both aspirin and streptokinase improved survival rates over the next 15 months, especially when taken together.

But doctors and patients alike really sat up and took notice of the unassuming little white pill a year later, when the results of Harvard Medical School's Physicians' Health Study were published. More than 20,000 male physicians were given aspirin with or without beta carotene (which was also being evaluated in this study). Men who were 50 years of age or older who took aspirin had a 44 percent lower risk of heart attack, compared with those who were given a placebo instead of aspirin.

The Physicians' Health Study showed—for the first time—that healthy men could take aspirin to help prevent a first heart attack, says lead investigator J. Michael Gaziano, M.D., a cardiologist and epidemiologist at Brigham and Women's Hospital and the VA Hospital in Boston. Because of this study, aspirin got “on the radar screen for the average person on the street,” he adds.

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And a study published last year found that men whose 10-year risk of developing coronary heart disease (CHD) was 7.5 percent or higher—could lower their heart attack risk by taking aspirin.

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What About Women?

Doctors began prescribing aspirin to men at high risk for heart attacks, but hesitated to give it to women, because there had been scant research on whether it would help them. But the results of two recent studies changed the picture.

In The Women's Health Study, researchers at Harvard and in Miami had nearly 40,000 women over the age of 45 take either an aspirin every other day or a placebo. The results, published in 2005, showed that over a 10-year period, the aspirin takers were less likely to have a stroke. There's more good news: for women over 65 years old, aspirin also reduced heart attack risk.

An analysis of data from a number of aspirin studies—including The Women's Health Study published last year—found that, “aspirin was most effective at reducing heart attacks in men, and most effective at reducing stroke in women,” says lead researcher Jeffrey S. Berger, M.D., a cardiology fellow at Duke University.

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Putting The Brakes on Stroke Damage

Another 2006 study showed that combining aspirin with drugs that lower high cholesterol and blood pressure may reduce the severity of strokes caused by blood clots. In this study, researchers asked 210 people who came to the hospital after a stroke whether they were taking aspirin, ACE inhibitors to lower high blood pressure or statins to lower elevated cholesterol. They also took brain scans of patients to look for areas of damage caused by the stroke.

While further study in larger patient samples is needed, patients taking a combination of the three drugs had less severe strokes and shorter hospital stays—and a greater percentage had better functionality upon leaving the hospital.

In the hours following a stroke, “part of the brain is essentially dead; you can't do anything about it,” explains Magdy Selim, M.D., Ph.D., an assistant professor of neurology at Harvard Medical School and co-director of the Stroke Center of the Beth Israel Deaconess Medical Center. “Part of the brain is borderline—you can save it. When you use this combination of drugs, the part of the brain that potentially you can save is a lot bigger,” adds Selim, one of the study's authors.

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No Magic Bullet

Research shows aspirin can help heart attack and stroke, as well as help limit the damage caused by these serious cardiovascular events. Since aspirin is available over the counter, you might be tempted to put down this magazine and run to the drugstore to stock up on super-sized bottles of maximum strength tablets. Don't.

Aspirin can have dangerous—even deadly—side effects, especially at higher doses or when taken with certain other drugs. To help prevent heart problems, doctors recommend taking a low-dose pill for people who are otherwise healthy.

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Aspirin may not be recommended for anyone who has:

* liver or kidney disease;

* peptic ulcer;

* other gastrointestinal diseases or bleeding;

* other bleeding problems;

* allergy to aspirin; or

* habitually excessive alcohol use.

“Aspirin is not a completely benign medicine. There are side effects,” cautions Berger. “It's very important that every single patient discusses the benefits and risks with his or her healthcare provider.”

The American Heart Association recommends that you call 9-1-1 and take an aspirin as soon as you are aware that you are experiencing symptoms of a heart attack—such as, discomfort in the chest or upper body (one or both arms, the back, neck, jaw or stomach), shortness of breath with or without chest discomfort, breaking out in a cold sweat, nausea or lightheadedness.

However, you should not take an aspirin if you think you are having a stroke. Some strokes are caused by bleeding in the brain, which can be made worse by aspirin.

And while popping a pill is a lot easier than sticking to a healthy eating and physical activity plan, aspirin can't keep heart disease at bay all by itself. Aspirin cannot take the place of a healthy lifestyle, says Berger. “Taking care of one's body makes people feel better, reduces the incidence of cardiovascular disease and it actually helps with a lot of the risk factors that promote cardiac disease.”

As far as he's concerned, anyone who is at high enough risk for heart disease that his or her doctor recommends aspirin needs to be especially careful to lead a healthy lifestyle. HI

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Be In The Know

The Food and Drug Administration recommends that if you are taking an immediate release low-dose aspirin (not enteric coated) and ibuprofen you should take the ibuprofen, at least 30 minutes after taking your aspirin or at least 8 hours before taking your aspirin to avoid any potential medication interacations.

If you are at risk for recurrent gastrointestinal bleeding and require low-dose aspirin, talk with your healthcare provider about also taking proton-pump inhibitors, like Nexium and Prevacid, to see if they are right for you.

Do not take low-dose aspirin without first consulting with your healthcare provider. Be sure to discuss all your medications, including those that you buy over the counter.

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All Anti-Inflammatory Drugs Are Not The Same

Aspirin is very different from commonly used nonsteroidal anti-inflammatory drugs, or NSAIDs, such as naproxen, ibuprofen and celecoxib.

While NSAIDs have similar effects on the body when it comes to relieving pain, reducing inflammation or lowering fever, only aspirin is recommended to prevent heart attack and stroke. Aspirin helps prevent heart attack and stroke because it discourages formation of blood clots.

Further, some NSAIDs are associated with an increase in cardiovascular disease risk.

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© 2007 American Heart Association, Inc.