Weighing the risks and benefits of a daily aspirin
More and more doctors are recommending their patients take a daily aspirin to prevent heart attacks and strokes. And recently, new studies have suggested aspirin might help with cancer prevention, as well. But why does aspirin help? And who really should be taking it? Lorraine Rapp and Linda Lowen, hosts of WRVO's health and wellness show "Take Care," spoke with the physician who first demonstrated the life-saving properties of aspirin, Dr. Charles Hennekens.
Lorraine Rapp: Why is aspirin so valuable?
Dr. Hennekens: Aspirin really, we should remember, is as old as medicine itself. But it really wasn't until 1970, that Sir. John Vane, who won the Nobel Prize for his work, demonstrated that small amounts of aspirin inhibited the tendency of platelets in the blood from sticking together, and there was reason that it might break the chain of events leading to a heart attack. And that's what led to the research that I started alone in the Physician's study that demonstrated that aspirin would prevent adverse heart attack, and the work I did with my colleagues and friends from Oxford University, where I had spent a year demonstrating the life-saving ability of aspirin when given during a heart attack and when, in fact, given to a wide range of survivors. It doesn't matter whether the occlusion is the heart, the brain or the peripheral artery, aspirin works.
Linda Lowen: Now in terms of treating it when you're talking about a daily dose of aspirin, what is that dose? Is that a low dose? Is that a regular dose? Give us some numbers.
Dr. Hennekens: It appears that the best benefit-to-risk ratio for aspirin for cardiovascular protection is between 81 and 325 [mg]. But I should mention as an aside, the latest studies that have mentioned randomized patients suggesting benefits in cancer may be the 325 [mg] dose, if that's the concern.
Lorraine Rapp: If you are someone who has never had a heart attack or stroke, but you might have a family history or high blood pressure, how do you know that you would benefit by taking a daily aspirin?
Dr. Hennekens: Even though it's an over the counter preparation, I would say the decision to use aspirin should be an individual clinical judgment based on the individual and their healthcare provider, that weighs the absolute benefits of aspirin, that it clearly protects adverse heart attacks and how we've shown that it prevents adverse stroke as well, but that has to be weighed against the risk. And it's only those patients that's at risk of an occlusion, outweigh the risks of bleeding. And that should be a decision made with your healthcare provider. I'm not in favor of using this without people getting the advise of their healthcare provider. And it's only those whose risk are sufficiently high to risk the side effects of the drug.
Lorraine Rapp: So Dr. Hennekens, the quality, or what's in aspirin that's helpful during the vascular events, is exactly what causes the problems. Are they working on developing something, a derivative of aspirin, where you get the good parts of it, but you cut down on the risks?
Dr. Hennekens: This has been going on for decades. It was first called the development of the non-specific anti-inflammatory drug, ibuprofens -- Motrin and Advil -- the naproxin derivative, Aleve. And then later, the specific Cox-2 inhibitors that relieve the pain that have less GI side effects. And what has been found in our latest publication, the Lancet, on May 17, 2013, the most comprehensive review of the worldwide evidence, is that aspirin looks the best in regards to cardiovascular protection. But I'd also like to point out that I don't think we'd want a society that's living longer like it is today because of living through chemistry. Regular physical activity, a brisk walk 20 minutes a day, or every other day -- and can be done into the oldest old -- can reduce your risk of heart disease 35 to 55 percent. Maintaining an ideal body weight, the same. Maintaining blood control, lipid control, glucose control, all of these things should be done in the therapeutic lifestyle area and the drug should be an adjunct, not the alternative.
More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday at 6:30 p.m. Support for this story comes from the Health Foundation for Western and Central New York.