Aspirin and Cardiovascular Health

Some cardiovascular medications function as antiplatelet drugs, which prevent tiny blood cells known as platelets from clumping together — the first step in the formation of a blood clot. Others dilate blood vessels or provide two medicines in one pill.

Aspirin is an old standby, yet it continues to surprise. This common, inexpensive drug helps protect survivors of heart attack and stroke from subsequent heart attacks and death, and even helps reduce the number of deaths that occur within the first hours following a heart attack. Although aspirin is best known as an antiplatelet drug, it may also subdue the inflammation that is central to coronary artery disease.

Randomized trials have provided clear evidence of aspirin’s value in both preventing heart attacks in men and treating coronary artery disease in both sexes. Over all, dozens of studies, involving tens of thousands of people, have shown that low-dose aspirin reduces the risk for heart disease and stroke by about 25%. A standard dose of aspirin to prevent heart attack is 81 mg per day, about what you’d find in a baby aspirin.

Guidelines from nearly every major medical group urge people with heart disease or at high risk for it to take aspirin. Although a major study reported in 2005 concluded that the advice is not as clear-cut for how to prevent first heart attacks in women (see Advice for Women), the prevailing consensus remains that in general, unless you are allergic to aspirin or it causes you problems, you should take it if you
  • have had a heart attack
  • have had an ischemic (clot-caused) stroke or a mini-stroke (transient ischemic attack)
  • have angina (chest pain)
  • have had a coronary artery bypass or angioplasty
  • have diabetes
  • are at high risk for heart disease.
Despite aspirin’s benefits, it also has some drawbacks. The evidence that its benefits exceed its risks is much stronger in men than in women, at least in terms of primary prevention (avoiding a first cardiovascular event). It can increase the risk for stroke and significant gastrointestinal bleeding. Even people who take aspirin occasionally with no problems could experience bleeding complications with regular use over prolonged periods. In particular, it may not be a good choice for people with uncontrolled hypertension (a major cause of hemorrhage into the brain). In such people, aspirin could more likely cause dangerous bleeding than prevent a heart attack. In addition, aspirin occasionally irritates the stomach lining without causing bleeding. However, these side effects can be reduced with the use of coated aspirin, which minimizes stomach irritation.

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