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The dramatic story of aspirin - one of our oldest remedies.

At the heart of aspirin research has been the knowledge that it inhibits clotting by preventing the clumping of the so-called blood platelets. Because coronary artery clots can produce heart attacks, researchers undertook numerous clinical studies of aspirin's effects in patients who had previous heart attacks. Pooling the results of 25 of these studies showed clear benefits to aspirin use--a 32 percent lower rate of subsequent nonfatal heart attacks, a 27 percent lower rate of nonfatal stroke, and a 15 percent reduction in overall death from heart disease.

A huge international study in the mid-1980s involved 17,000 patients admitted to hospital emergency rooms with suspected heart attacks, half of whom were immediately started on a 160 mg daily dose of aspirin. This amount--roughly half of a standard aspirin tablet--was continued for 30 days. The other half received a placebo. After five weeks, the death rate, as well as rates of nonfatal heart attacks and strokes, was significantly lower among those who received aspirin.

Based on this worldwide study's findings, virtually every heart attack patient should be started immediately on a daily aspirin dose of at least 160 mg. Those who evaluated this study say a standard 325 mg aspirin tablet may be preferable for the initial dose to more rapidly deliver an anticlot-ting effect. Such omission of aspirin therapy may result in more than 5,000 avoidable fatalities annually, says the American Council on Science and Health.

What are the possible side effects of using aspirin? Bleeding is the most feared, because it can produce stroke. Most strokes in the United States occur because of artery blockage in the brain--the so-called ischemic strokes. Although aspirin might lower the risk of ischemic stroke, it could theoretically induce the less common, but more serious, hemorrhagic stroke, in which bleeding occurs into the brain. Fortunately, low aspirin doses did not produce an observable increase in hemorrhagic stroke occurrence, or other bleeding-related events.

Prehospital use of aspirin could be particularly beneficial when formal hospital care is significantly delayed, such as on an overseas flight or remote camping trip. A simple, potentially life-saving policy would be for airlines to carry aspirin on all aircraft and to instruct personnel in administration procedures. This is not routine practice for U.S. air carriers.

Can aspirin prevent heart disease?

Beginning in 1982, Harvard researchers recruited 22,071 male physicians in the United States to take part in an aspirin trial. Half of the doctors were given one standard 325 mg aspirin tablet every other day while the other half received a lookalike placebo.

Five years later, the results were apparent. Those who took aspirin had a 44 percent lower rate of first heart attacks than those who took the placebo. Based on these impressive results, the U.S. Preventive Services Task Force recommended that preventive aspirin therapy be considered for men 40 and older who are at increased risk for heart attacks and for whom the drug poses no risk.

Despite these impressive results, the question still remains: Should everyone take low-dose aspirin, or should it be recommended only for certain persons, however remote the possibility of hemorrhagic stroke?

The best overall recommendation is based on the patient's cardiovascular disease risk profile (family history, smoking, and eating habits, etc.). Preventive aspirin seems more clearly indicated for certain categories of person: older men, individuals with elevated cholesterol levels, and those with strong family history of heart disease. However, experts are quick to point out that aspirin is no substitute for lifelong good health habits.

Additional Benefits of Aspirin

More recent developments have suggested even more extensive benefits of aspirin. One is preventing the serious complications associated with the high blood pressure (usually defined as 140/90 or greater) that occurs in 5-15 percent of all pregnancies. Another is that aspirin may reduce the occurrence or progression of periodontal disease by promoting blood circulation in the gums and by preventing degenerative breakdown of the bone in which the gums and teeth are set. Cataract prevention has likewise been seen as a possible benefit of aspirin. In the Physicians' Health Study, aspirin also appeared to prevent some migraine headaches.

Several recent studies suggest that aspirin may play a role in preventing or slowing the progression of colon cancer. The mechanism of this is unknown, but it may be related to the drug's ability to block production of prostaglandins, thought to be involved in cell replication in the intestinal lining.

Whatever these studies' outcomes, this least-costly and most widely used drug has demonstrated a remarkable ability to ameliorate more than the minor ailments for which it has traditionally been used.
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Publication:Medical Update
Date:Sep 1, 1993
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