Aspirin — Is it a Wonder Drug? Dr. Peter J. Rice gives the facts.
Aspirin is an old drug.
Developed in 1893 by the German pharmaceutical company Bayer AG, acetylsalicylic acid is a derivative of a pain relieving substance isolated from willow bark and other plants. It was one of the first non-opiate pain relievers. Aspirin was the original brand name, but its German company lost the trademark name during World War I as the name ‘aspirin’ became commonly used.
Prior to the development of acetaminophen and ibuprofen in the 1950s and 1960s, aspirin was the most common medication used for pain, fever and inflammation. Aspirin was used in all age groups until an increased risk of Reye’s syndrome, a potentially fatal brain disease, was associated with aspirin use in children and adolescents.
Uncle Bob was a merchant marine sailor and chief engineer on the USS Metapan. When he had a heart attack at sea in 1960, they treated him with aspirin for the pain as they evacuated him to the Public Health Service Hospital in Staten Island, NY. The aspirin probably saved his life; most of the other medications used at the time have been shown to be ineffective. We know today that aspirin is an antithrombotic agent that inhibits platelet aggregation and formation of blood clots.
In addition to its actions on pain and fever, aspirin is a unique drug that irreversibly inhibits a biochemical pathway responsible for blood platelets aggregating together to form a clot. Platelet aggregation is an important step that, under the wrong circumstances, can lead to heart attack or stroke. This action of aspirin occurs at low dosage, so even a baby aspirin or a low dose aspirin provide protection from blood clotting.
Should you be taking a daily aspirin to protect against heart attack or stroke?
Benefit versus risk is a continuing theme of medication use. The down-side of its use is that as it decreases health risks from clotting it increases health risks from bleeding.
As you consider whether you should take a daily tablet to prevent heart attack or stroke, think about your risk. If you are young and healthy, then your risk of heart attack or stroke is minimal; aspirin is unlikely to provide much benefit to you. However, as you get older and have an increasing likelihood of having a blood clot cause a heart attack or stroke, aspirin is more likely to help.
The best way to make a decision about whether a daily aspirin is right for you is with your primary care physician considering your individual risk factors for a heart attack or stroke.
Risk factors include age, high blood pressure, diabetes, smoking, cholesterol and underlying heart disease.
- You can check their 10-year risk for cardiovascular disease at: http://cvdrisk.nhlbi.nih.gov/calculator.asp
The US Preventive Services Force recommends aspirin for men age 45-79 and women age 55 to 79. These ages balance the benefits from aspirin with the risk of serious gastrointestinal tract bleeding. The recommendation is to take one baby aspirin daily or one 325mg aspirin tablet every other day.
It is interesting that there is a difference in benefit based on sex. In men, daily aspirin treatment decreases the risk of heart attack. In women, daily aspirin prevents strokes. Daily aspirin does not affect overall mortality.
It was a wonder drug in its time, and remains a wonder drug for prevention of colon cancer, heart attack in men, stroke in women.
Check with your primary care physician and see if a daily aspirin might be for you. We want to keep you healthy.
- Agency for Healthcare Research and Quality: Using Aspirin for the Primary Prevention of Cardiovascular Disease. http://www.ahrq.gov/professionals/clinicians-providers/resources/aspprovider.html
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