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An Aspirin a Day...' Just Another Cliche?

Or Should You Take This Advice to Heart?


Updated July 24, 2006

DOES NOT AFFECT THE HEART. That assurance in the Bayer aspirin ads of the 1920s spoke to concerns of the day that some drugs could damage the life-sustaining organ. Today it's clear that aspirin can affect the heart. Ironically, it turns out the effects are beneficial, so much so that some aspirin ads now carry the American Heart Association's seal to highlight the cardiovascular effects.

In fact, of the 80 million aspirin tablets Americans take each day, most are taken not for everyday aches and pains but to reduce the risk of heart disease, according to aspirin manufacturer Bayer Corp. (See graph.)

Based on studies showing aspirin's usefulness in treating cardiovascular disease, including heart attack and stroke, the Food and Drug Administration has approved its use to treat some of these serious conditions. Most recently, last October, FDA finalized a rule to give doctors updated information about the use of aspirin for men and women who have had a heart attack or stroke or are at high risk for them.

"Used the way it should be, the information should save a lot of lives, " says Debra Bowen, M.D., deputy director of an FDA drug review office."In addition, " she says, "the information should reduce adverse reactions and allow doctors to better target those who need to use the product. "

Beyond Pain Relief

As summarized in FDA's October rule and in the updated professional labeling for aspirin, the 100-plus-year-old drug has been shown to reduce the risk of the following medical problems:

  • stroke in those who have had a previous stroke or who have had a warning sign called a transient ischemic attack (mini-stroke)
  • heart attack in those who have had a previous heart attack or experience angina (chest pain)
  • death or complications from a heart attack if the drug is taken at the first signs of a heart attack
  • recurrent blockage for those who have had heart bypass surgery or other procedures to clear blocked arteries, such as balloon angioplasty or carotid endarterectomy.

Under the rule, the recommended doses for cardiovascular uses are lower than those doctors had been prescribing since this new use became popular: generally, 50 to 325 milligrams once daily (75 to 325 milligrams for angina and previous heart attack).

Scientists believe that aspirin's ability to reduce the body's production of hormone-like "prostaglandins" is both the reason for its effectiveness in relieving pain and reducing inflammation and its protective effects against heart attacks and strokes. Prostaglandins, it seems, can cause platelets in the blood to stick together, which can eventually lead to blocked blood vessels and prevent delivery of oxygen-rich blood to the tissues.

"When a clot forms in the brain, it can cause a stroke, and in the heart, a heart attack, " explains George Sopko, M.D., the head of the Interventional Cardiology Scientific Research Group at the National Institutes of Health. Reduce the prostaglandins, and you reduce the risk of dangerous blood clots, heart attacks, and strokes.

"Aspirin is a great drug: effective, cheap, and relatively safe, " Sopko says. "The drug has been used by just about everybody, so it may not have the sex appeal of newer drugs, but it can have a huge beneficial impact if used properly. Looking at aspirin's impact, on heart attacks for example, it may be equal to or better than some drug therapies that cost thousands of dollars."

Other pain relievers and fever-reducing drugs, such as acetaminophen, ibuprofen, naproxyn sodium, and ketoprofen, have not been shown to have aspirin's beneficial impact on cardiovascular health. "It's not the pain-relieving quality that is the major thrust of aspirin's beneficial cardiovascular effects, " Sopko explains, "but its pharmacological effect on platelets. "

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