Will an Aspirin a Day Keep the Doctor Away?

by Tania Houspian, PharmD 2011 | houspian@myhousecallmd.com

You’ve may have noticed that your grandmother takes an aspirin everyday as part of her arsenal of medications. You may wonder why she’s taking aspirin when she’s in no apparent pain.  When you asked grandma she replied with her sagely tone, “The doctor said its good for my heart.” You nodded, pretending to understand, and wrote the answer off as another one of grandma’s “senior moments.” Well, it turns out that this time grandma is right. Although her answer is a simplified version of the truth, it is the truth nonetheless. Before you start popping aspirin yourself, read on to find out who should take daily aspirin and how it works to help your heart.

Your good old friend, Aspirin

Aspirin has been around for a very long time. Felix Hoffman, a German scientist, was searching for a compound to help alleviate his father’s rheumatoid and synthesized acetylsalicylic acid (aka Aspirin) in 1897 during his search. The story of the creation of aspirin in contentious to say the least (numerous scientists claimed to have discovered the compound first) but we’ll stick to this fairytale story for now.  When initially discovered, aspirin was used primarily to help with pain and fever.  Flash-forward to the present day and you’ll find aspirin being used to prevent heart attacks and strokes. This is the part where you scratch your head and ponder, “How do pain and fever connect with preventing heart attacks and strokes?” We’re getting there.

How does aspirin work?

This is the part in biochemistry class where our thick-accented German professor would have us turn to a page-long diagram of all the enzymes and pathways aspirin interferes with and say, “Memorghize.” Don’t do that…it’s painful to say the least.  We like things short and sweet.  So, how does it work?  Aspirin stops the action of two kinds of enzymes: one that causes inflammation and the other that causes blood clots. Inflammation can lead to pain and fever. Blood clots can lead to heart attacks and strokes.

Blood clots you say?

Your body is a finely tuned machine, constantly repairing and renewing itself. One of the ways it does that is via clotting. When there is damage to any blood vessel in your system (think of a paper cut in your blood vessel) the damaged area releases a set of protein messengers that initiate your clotting cascade.  The clotting cascade causes a specific type of blood cell (called platelets) to become sticky and clump together. This clump of cells sticks to the vessel wall, plugging the hole and stopping the bleeding to allow for repair.  Think of it as high-tech bubble gum plugging a leaky pipe. Aspirin helps prevent this clotting, allowing your blood to remain liquid and clot free.

I don’t want to bleed. Why would I take aspirin?

Good question. As you get older, issues arise with blood flow and improper clot formation. As you age, your arteries stiffen and your blood flows less seamlessly.  When blood flow isn’t as rigorous, sticky platelets can bind together and form clots even if there isn’t any bleeding. Improper clotting can also be caused by cholesterol build up in arteries and veins or other sorts of damage to your blood vessels.  Problems arise not only clots form but also when a clot breaks free from the blood vessel wall and travels to other parts of your body (we call this an “embolism”).  Heart attacks occur when clots become lodged in the thin arteries that supply blood to your heart (these arteries are called “coronary arteries”). When the clot gets stuck, it stops all blood flow through that artery and deprives your heart of blood and valuable oxygen (this is not good…not good at all).  In a stroke, a clot travels up to the small vessels in your brain, gets lodged there and deprives your brain of blood and oxygen (also not good).

Should everyone take an aspirin a day?

Definitely not. Taking aspirin daily is for two types of people:

Type 1: People who need Primary Prevention


These are people who have never had a heart attack or stroke but are thought to be at high risk of having either one. These people may have combination of the following risk factors:

  1. High blood pressure
  2. High cholesterol
  3. Overweight
  4. Tobacco use
  5. Diabetes
  6. Physically inactive

Type 2: People who need Secondary Prevention

These are people who have already had a heart attack or stroke.  These individuals need their blood to remain clot free prevent another heart attack or stroke.  The fact that they have already had one puts them at higher risk of having another one.  Time to pop an aspirin.

Oh no, I smoke (am overweight, have Diabetes, etc.)!  Should I start taking aspirin?

Nope (unless you have an MD after your name).  Starting someone on regular aspirin therapy is something a trained clinician needs to decide.  There are risks involved with taking aspirin (such as bleeding and stomach irritation) so the risks and benefits need to be weighed by someone with experience with this sort of treatment.  If you fall into one of the categories mentioned above, make an appointment to see you doctor and talk about your need for preventive aspirin therapy.

Questions? E-mail the Author: houspian@myhousecallmd.com

References:

1. Hayden, M. et al. Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2002 vol. 136 no. 2 161-172

2. Pantrono, C. et al. Antiplatelet Drugs. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) CHEST June 2008 vol. 133 no. 6 suppl 199S-233S

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07 2010

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