Dr. Manoj Sharma-
Dr. Sharma is a Professor and Chair of the Social and Behavioral Health Department and an Adjunct Professor in Internal Medicine at the University of Nevada, Las Vegas (UNLV). He is a global expert in health promotion.
In 1988, a classic double-blind randomized controlled study of aspirin and carotene was conducted among 22,000 American male physicians of the ages 40-84 years. The study provided evidence for a 44% drop in heart attacks for participants who took aspirin. As a result, aspirin was taken by many people over the age of 40 years around the world for primary prevention of heart attacks, many of whom were not even prescribed this drug by their healthcare providers. However, 20 years later, in 2018, many studies reversed this recommendation and only advocated it for secondary prevention or for those who have had a heart attack or stroke. This message needs to be conveyed to people who have not had a heart attack or stroke and still think that daily intake of aspirin is beneficial.
The main problem with aspirin is its side effect of causing bleeding. As the person ages the risk of bleeding also increases. The most common form of bleeding is from the stomach and intestines, which can sometimes be life-threatening. While taking aspirin daily may reduce the chances of getting a clot-related stroke, it can increase the chances of a burst blood vessel in the brain leading to hemorrhagic stroke. Aspirin can also lead to allergic reactions. Further, aspirin increases the chances of bleeding if someone is on another blood thinner. It also increases the chances of bleeding with corticosteroids, some antidepressant drugs, and common non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. Taking some herbal and dietary supplements such as Omega-3 fatty acids, ginkgo, etc. with aspirin also increases the chances of bleeding.
However, as mentioned earlier, the role of aspirin in secondary prevention or for those who have had a heart attack or stroke is well established. A low-dose enteric-coated aspirin of 81 mg is usually prescribed in such cases. The enteric coating provides a shield, so it does not dissolve while passing through the stomach thereby reducing irritability to the stomach. If someone is regularly taking aspirin, it should not be stopped immediately, and a healthcare provider must be consulted before gradually tapering it to avoid blood clots from getting formed. If someone is having a heart attack, then one can immediately take aspirin while waiting for emergency services to arrive. It should however not be taken as a substitute for seeking emergency help during a possible heart attack.
Recently a newer class of drugs known as P2Y purinoceptor 12 (P2Y12) inhibitors have shown greater promise than aspirin in secondary prevention. Using these can be discussed with one’s healthcare provider if one has a history of heart attacks or stroke. However, no studies have been undertaken for primary prevention with these drugs.
For the prevention of heart attacks and stroke, lifestyle changes remain the most important means irrespective of whether one takes aspirin or not. These measures include eating healthily (controlling portion sizes and eating a variety of fruits and vegetables), getting regular exercise (at least 150 minutes of moderate-intensity physical activity per week), staying at a healthy weight (losing weight if overweight or obese), abstaining from smoking and alcohol, managing other ailments if present (such as high blood pressure, diabetes, and high cholesterol), and incorporating relaxation and stress management.
