Aspirin and Heart: Myths and Facts

Aspirin also known as acetyl salicylic acid was first extracted from willow bark and also several other salicylate rich plants.
Aspirin and Heart: Myths and Facts
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Aspirin also known as acetyl salicylic acid was first extracted from willow bark and also several other salicylate rich plants. Its mention is there in the "Third dynasty of Ur" in 2000 BC and was used as a pain killer, and in treating fever. The tablet form of aspirin was rediscovered in 1899 by Dr Felix Hoffmann and was patented by Bayer pharmaceuticals in USA. It has been a household remedy since then for fever and as a pain killer.

Aspirin's popularity declined after the development of paracetamol in 1956 and ibuprofen in 1962. In the 1960s and 1970s, John Vane and others discovered the basic mechanism of aspirin's effects, while clinical trials and other studies from the 1960s to the 1980s established aspirin's efficacy as an anti-clotting agent that reduces the risk of clotting in blood vessels. Aspirin sales revived considerably in the last decades of the twentieth century, and remain strong in the twenty-first with widespread use as a preventive treatment for heart attacks and brain strokes.

Aspirin for Preventing and treating a Heart Attack

The recommendations from several authorities like American Heart Association and European Society of Cardiology recommend taking a daily low dose of aspirin (if prescribed by your health provider)and that heart attack survivors, patients after angioplasty and bypass surgery regularly take low dose aspirin daily on a very long term. The low dose means 75 to 150 mgs per day which is not sufficient for its pain killing action of for treating fever. This is an accepted treatment based on several guidelines.

During Heart Attack

Taking aspirin also helps during a heart attack. In fact, people having a heart attack are often given an aspirin by emergency medical services. This may take place in the ambulance or in a hospital emergency room. Taking an aspirin as soon as symptoms start greatly improves the chance of survival by at least 20%. It is the simplest and the best first aid before patient reaches a medical facility. It is much more effective than sublingual tablet of nitroglycerine popularly called "Sorbitrate".

Should everybody start taking one tablet of low dose aspirin every day 

NO: You should not start aspirin therapy without first consulting your physician.  The risks and benefits of aspirin therapy vary from person to person.

Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding. Aspirin at present is recommended for preventing a heart attack in ONLY the following indications:

4. You've already had a heart attack or an ischemic stroke
5. You haven't had a heart attack, but you have had a stent placed in a coronary artery, have had coronary bypass surgery, or you have chest pain due to coronary artery disease (angina)proven by investigations.
6. You're a man with diabetes older than 50, or a woman with diabetes older than 60 with one more than additional risk factor.

Although aspirin has been recommended in the past for certain groups of people without a history of heart attack or angina, there was always a disagreement among doctors about this approach. Guidelines have changed now and aspirin is no longer recommended for primary prevention except in high risk diabetics. This is because the benefit conferred by aspirin can be nullified by the inherent bleeding risk. 

Taking aspirin isn't advised during a brain stroke, because not all strokes are caused by blood clots.  Most strokes are caused by clots, but some are caused by ruptured blood vessels.  Taking aspirin could potentially make these bleeding strokes more severe.

The best way to know if you're a candidate for aspirin therapy is to ask your doctor. You should not start long term aspirin on your own.

Prof Upendra Kaul is Executive Director and Dean, Fortis Escorts Heart Institute and Research Center and Fortis Hospital, Vasant Kunj, New Delhi
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