A recent study shows that aspirin can reduce the risk of myocardial infarction, but can also cause severe bleeding..
Doctors and pharmacists are well aware that the prophylactic properties of cardiological aspirin are based on its ability to inhibit blood coagulation..
But the ordinary visitor to the pharmacy who wants to protect the heart with the advertised over-the-counter aspirin does not always know about the reverse side of this coin - the risk of bleeding.
Not many people also heard about the effect of acetylsalicylic acid on the mucous membrane of the gastrointestinal tract.
A new study found that aspirin, although it reduces the risk of myocardial infarction and stroke, can also increase the risk of potentially dangerous bleeding..
Employees of Imperial College London and King's College of Great Britain analyzed data from 13 clinical trials involving more than 164 thousand participants without cardiovascular disease aged 53 to 74 years.
Scientists wanted to find out whether aspirin prevents cardiovascular events in this age category, as well as to clarify the risk of bleeding requiring hospitalization.
The results, published in the Journal of the American Medical Association, indicate two fundamental points.
Firstly, if you have never had a heart attack (primary prevention), taking low doses of aspirin by the regulator really prevents the risk of heart attack, stroke, and - most importantly - reduces mortality.
Secondly, with secondary prevention (after previous cardiovascular events), taking aspirin does not affect mortality and is associated with a high risk of bleeding. Simply put, it does not save life, but it adds problems.
“As a result of the treatment, we get more people with severe bleeding who need hospitalization than people who were saved from a heart attack and stroke,” says Dr. Salman Arein, a cardiology professor at McGovern School of Medicine at the University of Texas..
Dr. Arein explains that aspirin is a powerful antiplatelet agent that interferes with the “sticking” of platelets. Although platelets can participate in the formation of a deadly blood clot in the cerebral artery, they do not literally allow us to bleed at the slightest cut of the skin or, especially, damage to internal organs. Therefore, prolonged use of low doses of aspirin increases the risk of bleeding. This drug becomes even more dangerous if taken concurrently with popular anticoagulants. For example, with warfarin.
Today in pharmacies, as a rule, you can buy cardiological aspirin in doses of 75 or 100 mg per tablet. This is considered the “gold standard” for heart attack prevention. But here the principle of “one size for all” does not work. The results of a study published in The Lancet magazine require body weight to be considered..
Researchers analyzed data from nine clinical trials and found that the recommended dose of aspirin from 75 to 100 milligrams per day protected only those patients who weighed up to 154 pounds (70 kilograms).
Individuals with a greater body weight required doses of aspirin 300 mg / day or even higher to provide a statistically significant preventive effect.
Not surprising, because body weight affects the distribution of drugs in the body.
The ASPREE study examined the prophylactic effect with regular intake of 100 mg of aspirin against placebo. The project involved about 19 thousand elderly Australians and Americans aged 70 years and older who did not have cardiovascular disease, dementia or disability. The researchers found no evidence that aspirin had any prophylactic effect. Although participants taking aspirin showed a higher risk of bleeding.
Obviously, aspirin is not the best medicine for the heart today. The ASPREE study also showed that the risk of dying from any cause in this age group with aspirin is higher than with placebo..
So, is it worth taking aspirin to reduce the risk of heart attack or stroke? This is a difficult question if you are familiar with scientific facts. But there is an alternative that some foreign cardiologists strongly recommend. These are drugs from the group of statins (atorvastatin, rosuvastatin).
“Since the advent of statins to lower cholesterol, aspirin can no longer be considered the best option for prevention in people without a history of cardiovascular disease,” is the professional opinion of Dr. Robert Seagal, American cardiologist and founder of LabFinder.
According to another expert, Dr. Arein, statins inhibit the formation of cholesterol plaques in the arteries, and they "have proven effective in preventing heart attack and stroke".
“Statins are most effective for secondary prevention - to prevent the second and third events. Therefore, all patients who have had a heart attack and ischemic stroke (caused by a blood clot) should take statins as long as they tolerate them, ”Dr. Arein said in an interview with local media.
However, Seagal warns that statins are strictly contraindicated during pregnancy, lactation, as well as in severe liver diseases. We add that many drugs do not combine with statins..
“The latest study confirms the idea that aspirin should be used with caution in patients with risk factors for coronary heart disease and stroke, and that lifestyle changes and risk factor modification may be a safer strategy for preventing an event,” says Dr. Arein.
Among the simplest ways to protect against a heart attack:
• Regular physical activity
• A healthy diet low in saturated fat
• Strict restriction of refined sugar and simple carbohydrates
• Complete cessation of smoking and minimization of secondhand smoke
• Maintaining a healthy body mass index
• Effective control of hypertension and diabetes
Aspirin is not the best medicine for the heart. Without a healthy lifestyle, no drugs will provide reliable protection against heart attack and stroke..