Aspirin and Heart Attacks
There’s a popular myth out there… that an aspirin a day is a good strategy for preventing heart attacks or strokes in the first place, i.e. for primary prevention.
Fact is, it’s not, mainly because it is not really a safe drug: it can cause GI bleeding. Aspirin is beneficial as a strategy for secondary prevention, i.e. for people who have already had a heart attack, stroke, bypass surgery, angioplasty, or stent insertion.
My Thoughts? It’s simple. Don’t take an aspirin a day unless you have diagnosed arterial disease. If your doctor wants you to take aspirin for diagnosed heart disease, have a discussion about aspirin dosage and side effects first, and be on the alert for any GI upset or stool discoloration. Report to your doctor immediately if something isn’t right. For preventative measures, I prefer to use aspirin alternatives like nattokinase, fish oil, garlic, ginger, and turmeric instead. They are useful and safe natural blood thinners.
The Details on “an Aspirin a Day”
This tried and somewhat true cardiovascular mantra has been around as long as I can remember, a popular and inexpensive approach to help keep blood thin and prevent clots that trigger heart attacks and stroke.
Doctors often prescribe aspirin for both primary and secondary prevention but are always concerned about the threat of GI tract bleeding. The fact is that as many as 19,000 deaths a year are thought to be due to aspirin usage.
In my clinical practice, new patients would typically ask me about taking aspirin, even healthy patients wanting to improve their cardiovascular status. My answer: If you have arterial disease, an aspirin a day may be worth considering to keep the blood thin. If you don’t have it, forget the aspirin. The natural blood thinners don’t carry a risk for intestinal bleeding.
Among these new patients were individuals already taking aspirin for primary prevention (their doctors had told them to do so or they were doing it on their own based on hear-say). Quite a few had symptoms of aspirin side effects, including overt bruising and gastrointestinal bleeding. I got them off of that habit in a hurry.
According to recent guidelines from the U.S. Government’s Preventive Services Task Force, men from 45 to 79 should take an aspirin a day only when the potential benefits of a reduction in heart attack and stroke outweighs the potential harm of increased gastrointestinal bleeding. For women 55 to 79, the same recommendation applies for a potential benefit of a reduction in strokes. Neither men under 45 nor women under 55 are encouraged to use aspirin for cardiovascular disease prevention. As far as both genders over 80 years of age, there is no sufficient evidence to assess the balance of benefit and harm for prevention.
Aspirin as a Blood Thinner
Aspirin’s appeal comes from its ability to block the formation of thromboxane A2, a substance produced by activated platelets, cells in the blood that contribute to clotting. Too many platelets means too much clotting, a danger for people with occluded arteries to the heart and brain. More platelets also mean too much thromboxane, which makes things worse by constricting blood vessels. Too few platelets and you run the risk of bleeding.
Baby Aspirin vs. Aspirin?
- If I have cardiovascular disease, what strength aspirin should I use – a baby aspirin (81 mg) or a regular strength (325 mg)?
The issue is tolerance. I had perhaps a couple of dozen patients over the years who complained of GI upset, heartburn, or dark stool (a sign of GI bleeding) as a result of taking aspirin. In my practice I usually recommended 1 or 2 baby aspirins, depending on the situation, and I rarely had a problem. People were able to tolerate that dosage much better.
- Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med, 2009;150(6):396-404.
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