THE ASPIRIN CONUNDRUM: SHOULD YOU OR SHOULDN’T YOU?

Does a Daily Aspirin Protect You Against Heart Disease?

Should you take aspirin to protect yourself against heart disease?  The evidence has never been overwhelming.  Aspirin prevents only one heart attack a year for every 1000 people who take it . . . and causes a similar number of  major stomach bleeds.

This slim benefit applies only to people who don’t already have heart disease.  We call this primary prevention.  For people who already have heart disease — secondary prevention — it prevents a heart attack in 1 of 66 people who take it for a year, a substantial benefit.      

There’s more: A recent British study shows that a daily aspirin failed to prevent first heart attacks in people with diabetes.  The is an eye-opener, since diabetics are two to five times more likely to sufffer from heart disease than the general population. (BMJ 10/20/08) 

BILLIONS OF ASPIRINS DOWN THE HATCH                                                                                                                                              Over 50 million Americans, 36% of the adult population, take a daily aspirin to help protect against heart attack and death.  That’s billions of  aspirin doses for very little purpose.  Given the hundreds of thousands of major gastrointestinal bleeds that go with a daily aspirin and studies like the one mentioned above, experts are now skeptical about its use for primary prevention.

Aspirin works by making platelets more slippery, which inhibits clot formation.  The rapid blockage of an artery in a heart attack is caused by the rapid formation of a clot — the body’s response to an unstable athersclerotic plaque lining the artery wall that suddenly cracks.  

SCANT SCIENTIFIC EVIDENCE                                                                                                                                                                              It turns out that the widespread use of aspirin for primary prevention of heart disease  has scant scientific evidence to support it.  This isn’t the first time a drug has been recommended for widespread use without adequate research to back it up.  The use of hormone replacement therapy (HRT) in menopausal women and the use of anti-arrhythmia drugs in people with minor heart rhythm disturbances come to mind.  The premature death toll from these two treatments may haved been in the hundreds of thousands.

If medical researchers were willing to look more carefully at non-drug interventions, we might find ourselves with safer, effective treatments.  But our system favors drug interventions — for many reasons — including the profit motive, often at the expense of good medicine and public safety.  It’s relatively easy to set up a drug study, compared to a multi-disciplinary approach that emphasizes an anti-inflammatory whole foods diet, regular physical activity along with adequate vitamin D and essential omega 3 fatty acids.  There’s clearly a lot more money to be made from testing a drug, so it’s easier to fund a drug study.  Although aspirin is extremely cheap, the drug bias is so ingrained in our system, it’s hard to budge.  Of course, a multi-discliplinary approach to self-care demands, well, a healthy dose of discipline, compared to the ease of popping a pill every day.

DO THIS, DON’T DO THAT                                                                                                                                                                                           I tell my patients to focus on food, movement, D3 and omega 3s — a whole foods diet with adequate healthy fats, moderate amounts of low glycemic whole grains and plenty of vegetables and fruits, regular physical activity, adequate vitamin D and omega 3 fatty acids, usually in the form of fish oil.  Most people need at least 2000 IUs of vitamin D and 1000 mg total DHA plus EPA (add them up off the label — it usually 3 capsules).  Of course I can’t scientifically prove the benefit of such a rational, common sense approach, but it’s highly unlikely to increase your risk of a major gastrointestinal bleed.  TAKE HOME:  Skip the baby aspirin for primary prevention of heart disease.

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