Aspirin: The New Blockbuster Drug!

Does this sound like a familiar advertisement?  “Cardiomoxipow!  There is a brand new drug on the market (sure to be a blockbuster!) that cuts your risk of having a heart attack!!  It is called Cardiomoxipow! [echoing in the background – POW,pow, pow…]  You take it three times a day while standing on your head.  Cardiomoxipow!  It may have the side affect of turning you lips, teeth, and hair a lovely shade of blue.  [Hey! Nice hair!]  Cardiomoxipow!  And you can get it now for the low, low price of $3.99 per pill!!  Lower your risk of heart attack NOW with CARDIOMOXIPOW!! [large explosion]”

Well, part of the above is actually true.  There is a drug on the market that can decrease your risk of having a heart attack.  It’s called aspirin.  It was created in 1897.  You can get it at your local drug store for about 3 cents a pill.

So what is all the hype about aspirin?  What does it do?  Can it really prevent heart attacks?  What about strokes or other blood vessel problems?  Are there any side effects?  Why aren’t there any commercials with cute, fuzzy cartoon characters trying to sell it to me?

Thanks for asking!  That’s what I’m here to talk about!  Aspirin was developed by German chemist Felix Hoffmann in 1897 as a treatment for his father's arthritis.  It comes from Willow bark which has a compound in it called salicin from which we can make acetylsalicylic acid (thank you, spellchecker!), or aspirin.

How can a little white pill prevent you from having a heart attack?  Heart attacks happen when one of the blood vessels to the heart gets blocked off, partially or completely.  When this happens, blood can no longer get to that part of the heart muscle.  If this blockage continues for more than a few minutes, part of the heart no longer gets the oxygen and nutrients it needs and so the muscle cells start to die.  This is called a heart attack or a myocardial infarction, and can result in permanent heart damage or even death depending on how much of the heart muscle is affected and how badly it is injured.

This process usually starts with the gradual buildup over time of plaque (fatty deposits) in the walls of the arteries to the heart, or the coronary arteries.  People who are at greatest risk for this include those who smoke or have high cholesterol, diabetes, high blood pressure, or a family history of heart disease.

When a heart attack occurs, usually a clot forms in one of these narrowed arteries. Platelets, one of the types of blood cells, help form clots by becoming “sticky” and clumping together to form a plug.  So when we get cuts or scrapes we should all jump up and down and celebrate the fact that we have platelets to stop the bleeding.  But platelets also help to form the clot in the coronary arteries – a place where we really don’t want a clot.  Hmmmm…if there was only a way to make the platelets less sticky so they wouldn’t clump together like that.  Tah dah!  Enter aspirin!

When an aspirin molecule meets up with a platelet (“Howdy, platelet”) it binds to the platelet irreversibly (“You and I are sticking together until the end, buddy!”).  In doing this it makes the platelet less sticky and so makes it much less likely to help in forming clots (“Sorry to tell you this but I’m pulling you out of the game, bud…forever!”)  Because the aspirin binds so well to the platelets, even a low dose of 81 mg a day has been found to be effective in preventing heart attacks, and it does not seem that higher doses work any better.

So where is the proof that this works?  This is a subject of ongoing study and debate.  When looking at data from several of the major studies of people taking an aspirin a day, the US Preventive Services Task Force, one of the primary expert panels looking at disease prevention in the US, found that aspirin lowered the risk of heart attack by 28%, or almost by one-third.  There is even more evidence that taking aspirin can reduce the risk of recurrent heart attacks or strokes in people who have already had one of these or have known blood vessel disease.

Aspirin is not without risks, however.  Because aspirin can prevent platelets from forming clots it can also increase the risk of bleeding.  The same studies that looked at the good things that aspirin can do also showed that it can increase the risk of bleeding into the stomach and intestines and it can increase the risk of hemorrhagic stroke or bleeding into the brain.  Approximately 2 to 4 middle-aged individuals per 1,000 had major gastrointestinal bleeding when given daily aspirin for 5 years.  The risk of hemorrhagic stroke was 0 to 2 per 1,000.

So who should consider taking aspirin?  As with anything in medicine we have to weigh out the potential benefits of a given treatment against the potential harms.  The people to whom we would most likely recommend aspirin therapy are those who are at higher risk for heart disease.  The US Preventive Services Task Force recommends that physicians discuss aspirin therapy with men who are over 40, postmenopausal women, and younger individuals who have risk factors for heart disease like high blood pressure, diabetes, smoking, and high cholesterol.

Those that have had previous gastrointestinal bleeding or hemorrhagic strokes should not take aspirin unless directed to by your doctor.  These people have a higher risk of complications from aspirin so in this case the risks may outweigh the benefits.  Individuals with aspirin sensitivity or allergy and pregnant women also should not take aspirin.  Children and teenagers should not take aspirin due to possible risk of Reye’s syndrome.

So what are you saying, Dr. Hays?  Should I take aspirin or should I just go for Cardiomoxipow?  The latter sure does sound more exciting in the commercials!  If you fall into the higher risk category above you should have a discussion with your doctor about aspirin use.  Your doctor can use a calculation to determine your risk for having heart disease using the available information on your health status (age, smoking, family history, blood pressure, cholesterol).  Then together you can weigh out whether your benefits from taking aspirin would outweigh the risks. 

Now I’m going to make my own advertisement:  ASPIRIN! [echoing – IN in in]  Lower your risk of heart attack with the little white pill!  Talk to your doctor today about….Aspirin!  Three cents a day keeps the platelets away! [enthusiastic chorus singing “Aspirin!”] [Scene of scurrying platelets running away from happy, bounding, fuzzy, smiling, friendly aspirin pill which we will nickname “Aspy”]

Disclosure: The author would like to disclose that he does not approve of the term “blockbuster drug”, he does not have any financial interest in aspirin or any company that manufactures or sells aspirin, and he is not related to German chemist Felix Hoffmann.

Click to close window