Does Aspirin Actually Help to Prevent Heart Disease or Not?
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Blood clots, the leading cause of heart attacks and strokes, form when a plaque (cholesterol and other substances deposited on artery walls) ruptures and your body tries to contain the damage by creating a clot. When arteries are already narrowed by the buildup of plaque, a clot can block a blood vessel and stop the flow of blood to the brain or heart.
Although aspirin is inexpensive and widely available, especially in developing countries, there is lack of evidence that the benefits outweigh the adverse events with continuous aspirin use in primary CVD prevention. Therefore, the decision to initiate aspirin therapy should be an individual clinical judgment that weighs the absolute benefit in reducing the risk of a first cardiovascular event against the absolute risk of major bleeding, and tailored to the patient’s CVD risk. This risk must be calculated, based on accurate and cost-benefit locally developed risk assessment tools, the most discriminating threshold be identified. Additionally, patients preferences should be taken into account when making the decision to initiate aspirin therapy in primary prevention of CVD or not. Physicians should continuously be trained to calculate their patients CVD risk, and concomitant strategies be emphasized. Limiting aspirin use to only high-risk individuals negates the opportunity to prevent a significant number of cardiovascular events, many of which present as unheralded myocardial infarction (MI) or sudden cardiac death, especially in developing countries where alternatives to aspirin could be unaffordable by the large majority of primary CVD prevention populations.
In 1758, in the first recorded clinical trial in history, Reverend Edward Stone of the Royal Society of London demonstrated the efficacy of ground, dried bark from the English willow tree for treating the symptoms of malaria. However, aspirin as we know it today was not introduced for public use until 1904, following a series of attempts at extraction and purification of salicylic acid from willow bark and subsequent modification to acetylsalicylic acid to reduce the unpleasant side effects (Fuster V, Sweeny JM., 2011). In addition to its anti-inflammatory properties, aspirin was also observed to increase bleeding time, and later studies demonstrated the utility of aspirin as an antithrombotic agent.
When taken during a heart attack, aspirin slows clotting and decreases the size of the forming blood clot. Taken daily, aspirin's anti-clotting action helps prevent a first or second heart attack.
Soni A. Aspirin use among the adult U.S. non institutionalized population, with and without indicators of heart disease, 2005. Statistical Brief #129. Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey;
Fuster V, Sweeny JM. Aspirin: a historical and contemporary therapeutic overview. Circulation 2011;123:768–778.
Miner J, Hoffhines A. The discovery of aspirin’s antithrombotic effects. Tex Heart Inst J 2007;34:179–186