February 2008
Consider aspirin
Public-health authorities have long recommended a daily low-dose of aspirin for most people at increased risk for heart attack.
And it's now clear that aspirin also helps prevent first heart attacks in men over age 40 and in women over 65 who don’t have risk factors. Yet surveys show that many good candidates are not taking the drug—because their doctors failed to recommend
it.
How aspirin works
Aspirin belongs to a broad class of drugs called nonsteroidal anti-inflammatories (NSAIDs) that affect the body in surprisingly powerful ways. Most of those drugs, including the nonprescription ones—aspirin, ibuprofen, ketoprofen, and naproxen—block production of two enzymes called cyclooxygenase (COX)-1 and cyclooxygenase (COX)-2. The COX-1 blockage prevents certain blood cells called platelets from clumping together, a necessary step in the formation of blood clots; the COX-2 blockage prevents production of a key substance that contributes not only to pain and fever but also to inflammation.
As a result, all NSAIDs theoretically might protect the heart and the brain in two ways: by preventing blood clots that can trigger heart attacks and ischemic strokes (the kind caused by a plugged artery), and by easing inflammation, which can damage arteries.
However, only aspirin has been proved to reduce cardiovascular risk. It inhibits platelet clumping more and longer than other NSAIDs. And it turns out that the other NSAIDs pose unexpected heart risks, such as raising blood pressure, that undermine their possible benefits.
American Heart Association guidelines recommend aspirin for people at elevated risk for heart disease, especially those found to have at least a 10 percent risk of a heart attack in the next decade. And the U.S. Preventive Services Task Force suggests the drug for people who have a 3 percent or higher chance of heart attack or stroke in the next five years.
If aspirin appeals to you, keep these tips in mind:
Consider whether you’re a good candidate. Daily aspirin therapy is generally beneficial to men over age 40 and women over age 65; younger women generally don't benefit unless they have an unusually high risk of heart attack or ischemic stroke.
Consult your doctor. Aspirin is a powerful medication that can cause some serious side effects. Blocking COX-1, for example, can erode the protective lining of the stomach and intestines, increasing the chance of ulcers. And while the anti-clotting effect helps prevent heart attack and ischemic stroke, it also increases the chance of gastrointestinal bleeding and hemorrhagic stroke (the less common but more deadly kind).
In addition, all NSAIDs can potentially worsen kidney and liver disease. It’s important that your physician is on board.
Ask about dosage. The AHA recommends 75 to 160 mg a day as long as you're not at increased risk for gastrointestinal bleeding and hemorrhagic stroke. That dose isn't likely to be enough to quash the average headache, but for heart protection it is just as effective as—and safer than—higher doses. Downing an aspirin—preferably chewed—can also help stop an impending heart attack.
Don’t skip pills or stop suddenly, since that may cause changes in your blood that can trigger a heart attack. Even stopping aspirin before surgery makes sense only when the risk of bleeding clearly outweighs the risk of developing a blood clot. If you do interrupt aspirin therapy, try to resume it within 10 days.
For pain-relief, start with acetaminophen (Tylenol and generic)—it's generally the safest. If that’s not adequate, try an over-the-counter NSAID such as naproxen or ibuprofen and, if necessary (and if your doctor agrees), higher-dose prescription versions of those drugs.
People who regularly take non-aspirin NSAIDs may have a higher risk of heart attack than people who do not take these medications. Moreover, ibuprofen and possibly other nonaspirin NSAIDs may interfere with aspirin's anti-clotting effect, undermining that drug's heart benefits.
It’s best to take NSAIDS in low doses for short periods, to minimize those risks. For more information on choosing the best pain reliever, talk with your doctor and read our CR Best Buy Drugs report on NSAIDs.
How aspirin works
Aspirin belongs to a broad class of drugs called nonsteroidal anti-inflammatories (NSAIDs) that affect the body in surprisingly powerful ways. Most of those drugs, including the nonprescription ones—aspirin, ibuprofen, ketoprofen, and naproxen—block production of two enzymes called cyclooxygenase (COX)-1 and cyclooxygenase (COX)-2. The COX-1 blockage prevents certain blood cells called platelets from clumping together, a necessary step in the formation of blood clots; the COX-2 blockage prevents production of a key substance that contributes not only to pain and fever but also to inflammation.
As a result, all NSAIDs theoretically might protect the heart and the brain in two ways: by preventing blood clots that can trigger heart attacks and ischemic strokes (the kind caused by a plugged artery), and by easing inflammation, which can damage arteries.
However, only aspirin has been proved to reduce cardiovascular risk. It inhibits platelet clumping more and longer than other NSAIDs. And it turns out that the other NSAIDs pose unexpected heart risks, such as raising blood pressure, that undermine their possible benefits.
American Heart Association guidelines recommend aspirin for people at elevated risk for heart disease, especially those found to have at least a 10 percent risk of a heart attack in the next decade. And the U.S. Preventive Services Task Force suggests the drug for people who have a 3 percent or higher chance of heart attack or stroke in the next five years.
If aspirin appeals to you, keep these tips in mind:
Consider whether you’re a good candidate. Daily aspirin therapy is generally beneficial to men over age 40 and women over age 65; younger women generally don't benefit unless they have an unusually high risk of heart attack or ischemic stroke.
Consult your doctor. Aspirin is a powerful medication that can cause some serious side effects. Blocking COX-1, for example, can erode the protective lining of the stomach and intestines, increasing the chance of ulcers. And while the anti-clotting effect helps prevent heart attack and ischemic stroke, it also increases the chance of gastrointestinal bleeding and hemorrhagic stroke (the less common but more deadly kind).
In addition, all NSAIDs can potentially worsen kidney and liver disease. It’s important that your physician is on board.
Ask about dosage. The AHA recommends 75 to 160 mg a day as long as you're not at increased risk for gastrointestinal bleeding and hemorrhagic stroke. That dose isn't likely to be enough to quash the average headache, but for heart protection it is just as effective as—and safer than—higher doses. Downing an aspirin—preferably chewed—can also help stop an impending heart attack.
Don’t skip pills or stop suddenly, since that may cause changes in your blood that can trigger a heart attack. Even stopping aspirin before surgery makes sense only when the risk of bleeding clearly outweighs the risk of developing a blood clot. If you do interrupt aspirin therapy, try to resume it within 10 days.
For pain-relief, start with acetaminophen (Tylenol and generic)—it's generally the safest. If that’s not adequate, try an over-the-counter NSAID such as naproxen or ibuprofen and, if necessary (and if your doctor agrees), higher-dose prescription versions of those drugs.
People who regularly take non-aspirin NSAIDs may have a higher risk of heart attack than people who do not take these medications. Moreover, ibuprofen and possibly other nonaspirin NSAIDs may interfere with aspirin's anti-clotting effect, undermining that drug's heart benefits.
It’s best to take NSAIDS in low doses for short periods, to minimize those risks. For more information on choosing the best pain reliever, talk with your doctor and read our CR Best Buy Drugs report on NSAIDs.
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