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Does Aspirin Actually Help to Prevent Heart Disease or Not?

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In addition to relieving pain, lowering fever and reducing inflammation, aspirin can prevent blood clots from forming

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.

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Although aspirin has a well-established role in preventing adverse events in patients with known cardiovascular disease (CVD), its benefit in patients without a history of CVD remains under scrutiny. Current data have provided insight into the risks of aspirin use, particularly bleeding, compared with its benefits in primary CVD prevention

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.

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Aspirin is the most widely used drug in medicine (Soni A., 2005). In 2007, the Agency for Healthcare Research and Quality (AHRQ) reported that nearly 20% of adults in the United States reported taking aspirin daily or every other day, with this number increasing to nearly 50% in those aged 65 and older. Aspirin is also one of the oldest drugs in use, with a history dating back to the period of Hippocrates and Galen, when the bark of the willow tree was famous for its analgesic and anti-inflammatory properties. Records show its widespread use by ancient Mesopotamian, Greek, and Chinese civilizations

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.

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In any event, aspirin slows the blood's clotting action by reducing the clumping of platelets. Platelets are cells that clump together and help to form blood clots. Aspirin keeps platelets from clumping together, thus helping to prevent or reduce blood clots. During a heart attack, blood clots form in an already-narrowed artery and block the flow of oxygen-rich blood to the heart muscle (or to part of the brain, in the case of stroke)

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.

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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

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