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Aspirin - The Wonder Drug!

Dr. Narendra Bhag, MBBS, MD

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Aspirin is seen in every medicine cabinet, bottoms of hand bags, travel bags, and desk drawers. It’s long been the first thing to reach for when treating headaches, pain or fever. But recently this popular cure – all has been tipped for star status; as evidence emerges of aspirin’s beneficial effects on more serious, or even life – threatening diseases such as heart disease and cancer.

The reason for aspirin’s new found respect? Quite simple: a reduction in heart attacks. The results of an Italian study of patients with at least one risk factor for cardiovascular disease, but no history of heart problems, were published in THE LANCET in January 2001. They showed that a low daily dose of aspirin (100 mg a day) reduced the patients’ risk of death from cardiovascular cause by a staggering 44 per cent and also reduced the risk of experiencing non-fatal cardiovascular events, such as heart attack.

An American medic, Dr. M. Pignone evaluated the result of several large studies on the topic, and found that an aspirin a day could reduce the risk of heart attacks in healthy people, too. British Doctors, are hesitant in prescribing aspirin to healthy patients, but doctors of US are convinced, and are being encouraged to talk abut the benefits (and dangers) of aspirin with patients at increased risk of cardiovascular disease.

How it Works Wonders

Aspirin’s cardiovascular benefits are ascribed to its effects on platelets – tiny blood cells that are partly responsible, for forming clots, which cause heart attacks and strokes. Aspirin reduces the clotting ability of blood by making the platelets less sticky (anti-platelet effect). Scientists have also recently learned that tissue inflammation plays a significant role in heart disease, and they report that aspirin’s anti-inflammatory qualities help to protect inflamed and inflexible blood vessels, like those in patients with atherosclerosis (narrowed arteries).

Inflammation is the immune system’s first line of defence against injury or infection. It is caused by an increase in blood flow and a mass movement of immune cells into the damaged tissue. But even mild inflammation, which may occur with common ailments such as colds, can also harm tissue by causing changes in blood vessels that are similar to those seen in people at high risk for heart disease. In people with atherosclerosis, inflammation is part of an ongoing cycle of injury and healing in plaque-lined arteries, that can lead to clot formation. Aspirin works to interrupt this chain of events.

But aspirin’s strength may also be its weakness. Because it inhibits clotting, aspirin increases the danger of gastro- intestinal bleeding, either from an ulcer or gastritis. It also raises odds of rare form of stroke, known as and haemorrhagic stroke, caused by bleeding in the brain. GP’s in the UK fear that these risks may outweigh the preventive benefits of taking aspirin if a patient does not demonstrate a clear-cut clinical risk of cardiovascular disease.

Dr. Pignone measured aspirin’s benefits against all its potential downsides, and although his British counterparts may disagree, sums it up this way: ’ Once you are over 50, unless you have absolutely pristine blood pressure and cholesterol and none of the other risk factors for heart disease, you should talk to your Doctor about taking a daily low- dose aspirin.’ If you’re under 50 and have any risk factors for heart disease – you smoke, have diabetes, are overweight, or rarely exercise, for example – you should also consider the drug, he claims. People with uncontrolled high blood pressure, however, should bring their pressure under control first.

People under 50 with a low risk of heart disease probable don’t need it, as the side effects for them may be greater than the benefits. So does he take a daily aspirin? No, I am 35, have normal blood pressure and cholesterol, I exercise, don’t smoke, and don’t have diabetes, he reports. My risk of developing cardiovascular disease in the next five years is very low.

Unfortunately, many people who would benefit from aspirin therapy – patients with a history of heart attack or stroke, or clinical evidence of a risk of heart disease- are not getting it, perhaps misled by its familiarity into doubting its powers. Only 30 to 40 per cent of the people who have most to gain from the drug are taking it and British medical efforts are focused on addressing this shortfall before broadening the drug’s use.

Physician, Health Aid Clinic and Hospital, 482-4, Bees Dukan, Adarsh Nagar, Jaipur-302004 Ph: 2613456

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