Aspirin & Heart Disease
It all began in 1897, when German chemist Felix Hoffman discovered aspirin by chemically modifying salicylic acid to reduce its irritant properties. … or did it?
A natural form of aspirin from myrtle, willow, and meadow sweet has been used since at least 2500 B.C.. The Assyrians in the Sumerian period utilized willow leaves to treat inflammatory joint pain. Egyptians also used willow leaves or myrtle for inflammation and joint pain. Hippocrates also recommended a willow bark extract to treat fever and pain, as well as during childbirth. The ancient Chinese, Roman, and Native American civilizations have also long recognized the benefits of plants that contains salicylic acid for medicinal benefit. However, synthetic aspirin, was born in a Bayer laboratory in 1897, and went to market February 1st, 1899.
However, it wasn't until the 1950s that aspirin was utilized in cardiovascular disease prevention. A general practitioner in California found that overweight and sedentary patient's, 45 to 65 years of age, and who took aspirin had less heart attacks. By the 1960s further scientific research identified the role that aspirin played in reducing platelet aggregation. By the 1970s, it was further discovered that it also inhibited prostate gland and synthesis. And, in 1982, a Nobel prize was awarded for this discovery. Aspirin had become a well establish drug in the treatment and prevention of cardiovascular disease.
Furthermore, research in the 1980s demonstrated that patients on aspirin therapy had a 40% lower risk of developing colon cancer. Later studies demonstrated that patients with risk of hereditary colorectal cancer did have a statistically significant reduced incidence of colonrectal cancer. Beyond this, even more recent studies have demonstrated that there is a potential benefit in overall reduction of metastatic spread and establish cancer for those patients who utilize aspirin therapy.
More recently, the medical literature has been addressing the potential negative effects of aspirin. Even major medical institutions have put out publications addressing his topic. Stating that aspirin. may not be good for you. Not only is there increase risk for gastrointestinal bleeding, but for those people with gait instability, and with an increase fall risk, there's an increased risk of majoring bleeding.
So, should we all take aspirin? Will it save my life, or your life? Will it prevent us from having cardiovascular disease?
No, and yes. But, also, maybe… and not really. It’s complicated. Let’s talk about it…
DISCLAIMER: As a general rule of thumb: if you have established cardiovascular disease, your healthcare specialist has likely place you on some type of anti-platelet therapy. Whether it is aspirin or something else such as clopidogrel. You were placed on this therapy for a specific reason. A reason where the benefits outweighd the risk. If you have been placed on an anti-platelet therapy by your healthcare provider, please do not stop it based upon things that you read on the Internet, or because a friend or fmaily member recommended it. Please speak with your healthcare provider/team before discontinuing any medication that you are prescribed.
The ASCEND trial was a randomized trial that evaluated the effects of aspirin and omega-3 for patients with diabetes. The outcome of the trial found that aspen reduced the risk of major cardiovascular events by 12% in comparison to placebo. However, the study also isolated that this reduction could somewhat be offset by an increase in major bleeding risk.
The ARRIVE trial valuated the effects of Enterra coded daily aspirin versus placebo on people with a moderate risk of cardiovascular disease. This trial found that there was no statistically significant difference in primary outcomes between the aspirin and placebo groups. However, the risk of first mortal infarction was lower in the aspirin group, and who wore at least 60% compliant with aspirin utilization.
The ASPREE trial evaluated the effects of daily aspirin therapy for people, aged 70 and older, without a background of heart, disease, dementia, or disability. This trial found no survival benefit, but did find a higher all cause mortality in the group that did take aspirin with an increased death secondary to cancer.
However, the seAFOod trial did identify a statistically significant reduction in the total risk of colorectal polyp formation, which is a risk for cancer development, in patients utilizing aspirin therapy. However, this trial was conducted in combination with fish oil. Also, the ASPECT trial found that combination therapy of aspirin and omeprazole significantly reduce the rate of death from esophageal adenocarcinoma, and high-grade dysplasia, in patients with Barrett's esophagus.
Furthermore, the American Heart Association has published a met analysis of 10 aspirin primary prevention trials that found that the reduction of cardiovascular events was attenuated with increasing weight. Meaning that low-dose aspirin therapy was less effective in patients with a higher BMI.
That said, the recommendation remains that for adults ages 40 to 59 years of age with at least a 10% or greater 10 year CVD risk should consider aspirin therapy for primary prevention of cardiovascular disease.
It is not recommended that patients aged 60, or older, initiate aspirin therapy for primary prevention of cardiovascular disease.
However, if you have an established diagnosis of cardiovascular disease, you may benefit from aspirin therapy. Please discuss aspirin therapy with your cardiovascular specialist before initiating or stopping it. If you are not established with a cardiovascular specialist, please have an in-depth discussion with your primary care/general practitioner as to what your persona risks are, and whether or not you have any potential to benefit from either starting, or discontinuing, aspirin.
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