Don’t have a heart attack, but Aspirin is not the answer

"One a day keeps the doctor away” or so the saying goes.  Of course, your Grandmother was referring to apples when she said that.  Ever notice that the more time rolls on, the more we realize that Grandma knew her stuff? The modern version of the “one a day to keep the doctor away” saying looks a little different.  Now-a-days, the saying really goes… “An aspirin a day keeps the heart attack away!” How many people reading these words right now are under the impression that taking a small dose of aspirin every day will help keep your blood thin or affect inflammation, and thus make you less likely to die from a heart attack?  Certainly we read about it in the paper.  Our neighbors talk about it and do it.  Our doctors may have even recommended it to us. And what could be the harm anyway?  Certainly, we all know that too much aspirin can cause stomach bleeding and ulcers, but this is just a baby’s dose, right?  What could be bad about that? I’ll answer that question later... but first, let us really explore what the science says about aspirin and its ability to help prevent us from dying from heart attacks. But, to begin with, I have to say a few words about “science,” “scientific data,” and the “proper interpretation” of that data.  Far and wide, the most common reason I get from physicians for not using herbs and/or nutritional supplements is because of the lack of “scientific” evidence supporting its use.  Occasionally this is a valid reason and further exploration is needed.  More times than not, there is scientific data available, sometimes huge volumes (as in the case of garlic for high blood pressure), but it gets ignored by mainstream medicine. The real point, however, is that many medical practitioners rely on someone else to interpret the information from studies for them, studies about drugs included.  Very few doctors take the time to get a copy of the full study, read the data, and then interpret the data for themselves.  Sometimes the interpretation is left up to medical journals, like the Journal of the American Medical Association (JAMA), or to the companies that sponsor (pay for) the studies, like pharmaceutical companies.  Obviously, there are political and financial concerns that can skew the so-called results or conclusions of a particular study, depending on the point of view of the authors or reviewers. Of course, in a perfect world the whole idea behind a study is to find the truth out about a topic.  But we don’t live in a perfect world, and it is a well-supported fact that medical science in this country often times has blinders on.  And I believe that this is the case with the scientific data supporting the use of aspirin and the prevention of dying from a heart attack. To date, the studies statistically show that taking aspirin does indeed lower the incidence of non-fatal cardiac events… but it does not reduce the mortality rate from cardiac events.  How do we explain these confounding results? For starters… can I just emphasize again that in the large, long-term trials after myocardial infarction there is no evidence that aspirin saves lives!  And bothersome as this is, aspirin actually increased the risk of sudden death in the same studies. Here are two possible explanations for this interesting phenomenon…  

1. Aspirin may actually be concealing cardiac events instead of preventing them.  Aspirin is a pain reliever, and it is possible that the pain from a cardiac event is alleviated enough so that the person does not realize they are having a heart attack.  In essence, people taking aspirin may be more likely to have a “silent” heart attack.  Additionally, chest pain may be mistaken for the gastritis that often is associated with aspirin use.  These people may be more likely to go untreated for a heart attack, and thus be more likely to “die suddenly”.
2. Aspirin is a blood thinner.  This may be a reason for the conversion from non-fatal events into fatal ones.  The increased risk of bleeding is one factor that can lead to death during a cerebral or myocardial infarction.

  Another large part of this story has to do with the bias in interpretation that seems to be evident in some of the studies.  Some of the trials actually lost up to 25% of their patients to follow-up.  A standard might be to assume death of the patients in the treatment group, which would have nullified any statistical advantage from taking aspirin.  Also, upon reanalysis of the data from some of the trials, a remarkable thing happened… there seemed to be a resurrection of a number of apparently dead patients and the discovery of a number of new deaths.  This sort of discovery brings to mind recent political races instead of supposedly hard-core scientific inquiry. While I’m dispelling all of the myths, we should also discuss the supposed safety of aspirin… even at low dosages. Going back to the studies, they show aspirin to be very safe.  However, the designs of the studies were such that patients at risk for adverse effects from aspirin were excluded and the people in the studies tended to be of younger age.  And yet, in practice, it tends to be the older folks who are told to take an aspirin a day. Other studies have asserted that low dose aspirin use for cardiovascular prophylaxis may account for more than 30% of all major gastrointestinal hemorrhage in patients over the age of 60.  Of note here is that term low dose, which blows out of the water the theory that a baby dose of aspirin can’t be harmful.  Long-term aspirin use has also been linked to the formation of posterior subcapsular cataracts, the most common and most disabling form. Aspirin also has been linked to numerous adverse drug interactions, the most serious of which may involve its concomitant use along with ACE inhibitors, a very popular blood-pressure lowering medicine, especially with the elderly. Aspirin may negate the potential benefits of this medication. The very low cost of aspirin has been touted as a major advantage in using it as a heart attack preventative.  And, I guess if you compare the cost of aspirin to the cost of newer, patented prescription medications, you would think that the aspirin is a bargain.  But what about the cost of the other effects of taking the aspirin, including the very expensive medicines prescribed for “gastritis” and the hospitalizations that might occur from stomach bleeding.  And how do we put a cost on the false security that taking the baby aspirin every day will prevent you dying from a heart attack? And most importantly, what about the other things that could be done to really prevent heart attacks that get ignored because of the thought that aspirin is already doing the job?  I think that there are millions of people right now walking around thinking that they can super-size their fries or neglect their exercise because of the aspirin that they take… and herein lies what I believe to be the biggest danger! You see… once again grandma knew just what she was talking about!  If you are looking to protect your heart, here is the simple truth…  

1. Eat your fruits and vegetables… the more colorful the better!
2. Get your exercise… and make sure that you enjoy whatever activity you choose.  Have fun!
3. Get proper sleep… your body’s ability to regenerate and repair relies on certain “down-time.” (see the article “A Bright Idea...Turn Off the Lights”)
4. Enjoy the work that you do… the most common time for someone to have a heart attack is Monday morning… that is no coincidence.
5. Consider taking a high quality fish oil supplement… studies have shown that the healthy fats in fish oil not only decrease death from heart attacks, but death from all causes.

  Does this mean that you should stop taking your aspirin if your doctor has prescribed that you do?  Absolutely not!  What it does mean is that you should educate yourself about this topic more fully, and then you’ll be able to make a better-informed decision for yourself.  You should broach the topic with your doctor… but be prepared for the status quo answers, including the always popular… “I’m the one that went to medical school… what could that wacky pharmacist know that I don’t?” If you have read this article and still want to take aspirin for its “supposed” health benefits then it may be reasonable to adopt a plan that has you taking a baby aspirin every 3 days instead of daily. This may result in less potential for side effects while maintaining any “possible” benefit aspirin may have. And the next time you see your Grandma, give her an extra big hug and tell her thanks!