Baby Aspirin Is Enough To Protect The Heart Study Finds
Results presented at the American College of Cardiology’s 70th Scientific Session show most patients prefer a smaller dose and are more likely to stick with it.
Aspirin is the most common drug used after people have a heart attack, stroke, or bypass surgery, but until now doctors have not had clear evidence whether its best to give patients a low dosethe 81-mg baby aspirinor a regular 325-mg dose.
A head-to-head comparison found the lower dose works just fine, as there were no significant differences in cardiovascular or major bleeding events in the 15,076-patient, real-world trial presented today during the 70th American College of Cardiology Scientific Session.
There was, however, better adherence with the low dose, so starting with the baby aspirin may be the best choice for most patients, said Schuyler Jones, MD, assistant professor of medicine at the Duke Clinical Research Institute and lead author of the study, called ADAPTABLE. Results were simultaneously published in the New England Journal of Medicine.1
While many praised the trials pragmatic design, it had one big downside: doctors could not stop patients from changing doses, and many did. As a result, a commentator in the Journal questioned how reliable the findings are and whether investigators should have run a pilot that would have revealed this problem.2
Results were as follows:
References
Make It Easy To Remember
Here are a few things that may help you remember to take aspirin regularly:
- Take it at the same time every day. For example, take it after you brush your teeth or when you eat breakfast.
- Put a reminder note on your bathroom mirror where you will see it each day.
- Use a weekly pillbox to keep track of the medicines you take each day.
Fact: Daily Aspirin Can Be Safest When Prescribed By A Medical Health Professional
Before deciding if daily aspirin use is right for you, your health professional will need to consider:
- Your medical history and the history of your family members
- Your use of other medicines, including prescription and over-the-counter
- Your use of other products, such as dietary supplements, including vitamins and herbals
- Your allergies or sensitivities, and anything that affects your ability to use the medicine
- What you have to gain, or the benefits, from the use of the medicine
- Other options and their risks and benefits
- What side effects you may experience
- What dose, and what directions for use are best for you
- How to know when the medicine is working or not working for this use
Make sure to tell your health professional all the medicines and dietary supplements, including vitamins and herbals, that you use even if only occasionally.
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Emerging Evidence On Aspirin And Statins
More recent guidelines, issued in 2019 by the American Heart Association and the American College of Cardiology;recommend statins as the first medication most patients should try for primary prevention and discourage routine use of aspirin for this purpose owing to bleeding risks. The benefits for secondary prevention, meanwhile, must be balanced against bleeding risks for aspirin, particularly for older patients.
But the idea that aspirin isnt the first pill everyone needs for heart health runs counter advice that has shaped a generation of doctors and patients, says Ian Kronish, MD, MPH, of the Center for Behavioral Cardiovascular Health at Columbia University Irving Medical Center in New York City.
A pivotal study published in the late 1980s in the New England Journal of Medicine found that daily low-dose aspirin reduced the risk of heart attacks by 44 percent, driven in large part by results seen in adults over 50. In this clinical trial, aspirin didnt reduce mortality from cardiovascular causes.
More recently, a study published in October 2018 in the New England Journal of Medicine found that aspirin didnt help healthy older adults without cardiovascular disease live longer. In fact, this study, which focused on adults 70 and older, found aspirin was associated with an increased risk of premature death from all causes, driven by cancer fatalities.
Is There More Harm Than Benefit
Previous guidelines from the United States Preventive Services Task Force warned against taking aspirin for the primary prevention of heart disease unless youre at an elevated risk typically if youre 50 to 69 years old with a 10 percent or greater chance of having a heart attack or stroke within the next 10 years.
There is good reason to be wary of aspirin, warns Michos, particularly for women. The Womens Health Study was a large trial that looked at whether women with no history of heart disease would benefit from taking a low dose of aspirin. Researchers found that in the overall group of women, aspirin didnt reduce the risk of heart attacks, but it did increase the risk of bleeding. Some benefit was seen for women over the age of 65.
So not only was there lack of benefit for the younger women taking aspirin, but there was also a question of harm, says Michos. Its important for people to realize that just because aspirin is over-the-counter does not mean it is necessarily safe. Many patients take aspirin because they think its good for their hearts, but it carries some serious risks.
The best way to assess your risk level is to talk to your doctor about it. Your doctor can help you weigh the risks and benefits to determine if low dose aspirin therapy is right for you.
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Aspirin For Heart Attack First Aid
The reason you need aspirin;is the same reason you should call 911 without delay: A heart attack is a dynamic event, and early intervention can limit the damage. The paramedics can give you oxygen and medication, and they’ll monitor your blood pressure and heart rhythm to forestall complications as they speed you to the ER. In the hospital, doctors will take EKGs and blood tests to see if you are having a heart attack; if so, they will usually try to open the blocked artery with an;angioplasty;and;stent;or, if that’s not available, with a clot-busting drug.
It’s modern cardiology at its best, and it has improved considerably the outlook for heart attack victims. But how can a humble aspirin tablet add to high-tech medicine, and why is speed so important?
Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract;platelets;to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or;thrombus,;builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die and it’s a heart attack.
When To Call The Doctor
Side effects can be any signs of unusual bleeding:
- Blood in the urine or stools
- Nosebleeds
- Unusually heavy menstrual bleeding or unexpected vaginal bleeding
- Vomit that looks like coffee grounds
Other side effects can be dizziness or difficulty swallowing.
Side effects include swelling in your face or hands. Call your provider if you have itching, hives, or tingling in your face or hands, very bad stomach pain, or a skin rash.
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Prevents Blood Clots From Forming
Baby aspirin is a highly recommended anti-platelet medicine given in case there is a serious situation of blood clotting. Generally, you advise baby aspirin to patients who have just had bypass surgery, heart attack, stroke, atrial fibrillation,and acute coronary syndrome. This is because the reduction in blood clots clears the arteries and resumes the smooth passage of blood in the same.
Strokes Are Different From Heart Attacks:
Anyone who suspects a stroke, however, should avoid taking aspirin. In such a situation, it could make a bleeding stroke worse. Emergency physicians will determine the type of stroke before deciding on the appropriate treatment. A person who experiences a stroke caused by a blood clot in a blood vessel leading to the brain might be advised afterwards to take low-dose aspirin to prevent a recurrence. The evidence on that is still evolving, however, and the doctor may prescribe something different for secondary stroke prevention.
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Serious Bleeding 5 Times More Common
The new study shows that taking more than 100 mg of aspirin a day increases the risk of bleeding — from nose bleeds to bleeding in the brain.
For example, Serebruany says serious bleeding — like bleeding in the brain or in the stomach — occurs in just more than 1% of heart disease patients taking a baby aspirin . But serious bleeding occurs in 5% of heart disease patients taking 200 mg or more of aspirin daily.
When all bleeding was considered — including minor instances, such as nosebleeds — 100 to 200 mg of daily aspirin led to bleeding in 11% of patients. Bleeding occurred in just more than 3% of patients taking a baby aspirin.
Serebruany says his study does not address how well different doses of aspirin prevent heart attacks. “I think it is very probable that low-dose aspirin is as effective as higher doses to prevent second heart attacks.”
Where Did The Story Come From
This was a conference abstract of a study carried out by researchers from Leiden University Medical Center and Nijmegen University Sanquin Research both in the Netherlands. It was funded by Leiden University Medical Center and the Netherlands Heart Foundation.
The summary was presented this week at a meeting of the American Heart Association. The research has, to the best of our knowledge, not yet been peer-reviewed.
The study was covered widely in the media. Many newspapers tended to overstate the findings and did not mention the study has not yet been published. Though the Daily Mail did include useful comments from independent experts in the UK, while the Daily Telegraph mentioned the risk of side effects from aspirin.
The medias leap that the observed reduction in platelet reactivity would result in reduced risk of heart attack is an assumption that should not be made at the current time.
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Aspirin For The Heart: One Dose Doesnt Fit All
Aspirin Therapy, heart attack and stroke
For decades, millions of Americans have been advised to take low dose aspirin daily to prevent heart attacks and strokes. But new research is raising questions about this common practice.
Its not that aspirin doesnt work to keep the heart healthy. It does. Its just that the dose your doctor wants you to take may need to change in order to be right for you. Doctors recommend aspirin because it helps to prevent clots from forming that can block blood flow to the heart or brain, causing heart attacks and strokes.
The American Heart Association has recommended that people at high risk of a heart attack take a daily low-dose aspirin if their doctors recommend it. People who have had a heart attack are often advised to take it to prevent them from having another heart attack.
The new study found that a persons weight affects whether aspirin helps to prevent a heart attack or not. Low-dose aspirin works best for people who weigh between 110 and about 153 pounds. It doesnt prevent heart attacks in people who weigh more than about 154 pounds. And when heavier people on low-dose aspirin have a heart attack or stroke, theyre more likely to die from the heart problem than people on aspirin who weigh less.
What does it all mean? Some people may be taking too much aspirin and others too little. And your weight may be an important new factor in how much aspirin you take.
What Precautions Do I Need To Take
Limit alcohol
Drinking 3 or more alcoholic drinks every day while taking daily aspirin increases your risk for liver damage and stomach bleeding. If your doctor recommends aspirin, limit or stop alcohol usage.
Talk to doctor before a surgery or procedure
Before having a surgery or procedure that may cause bleeding, tell your doctor or dentist that you take aspirin. Aspirin may cause you to bleed more than usual. He or she will tell you if you should stop taking aspirin before your surgery or procedure. Make sure that you understand exactly what your doctor wants you to do.
Do not suddenly stop taking aspirin without talking to your doctor first. Talking to your cardiologist first is especially important if you have had a stent placed in a coronary artery.
Tell your doctor if you notice that you bruise easily or have other signs of bleeding. These include bloody or black stools or prolonged bleeding from cuts or scrapes.
Tell your doctor about all your medicines
Aspirin should not be taken with many prescription and over-the-counter drugs, vitamins, and natural health products. So before you start aspirin therapy, talk to your doctor about all the drugs and other remedies you take.
Be careful taking pain relievers
Take NSAIDs safely. If you need both aspirin and an NSAID pain reliever every day, talk to your doctor first. Ask your doctor what pain reliever you should take. You may be able to use another type of pain reliever, such as acetaminophen, to treat your pain.
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Don’t Take Aspirin To Prevent Heart Attacks New Study Suggests
For decades, doctors have recommended that healthy adults take a daily regimen of low-dose aspirin to help prevent cardiovascular problems, but the American College of Cardiology and the American Heart Association reversed that position on Sunday after a new study showed little benefits, and could even cause harm in some older people.
The most important way to prevent cardiovascular disease is by adopting heart healthy habits and to do so over ones lifetime, Roger S. Blumenthal, MD, FACC, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease said in a statement. More than 80 percent of all cardiovascular events are preventable through lifestyle changes, yet we often fall short in terms of implementing these strategies and controlling other risk factors.
The large clinical involving participants from around the world found that a daily low-dose aspirin had no effect on prolonging life for healthy, elderly people. In fact, researchers found a link between the daily pills and major hemorrhages. The study, conducted over a four-year span, enrolled more than 19,000 people in Australia and the United States who had a high risk of dementia or cardiovascular disease. Half of the participants were given 100 mg of aspirin, with the other half given a placebo.
What Did The Research Involve
According to the abstract, 290 people taking aspirin for prevention of cardiovascular disease were randomised to take 100mg aspirin on awakening or at bedtime during for two periods of three months. At the end of each period, ambulatory blood pressure and platelet reactivity were measured. Of the 290 patients taking part, 263 had their blood pressure measured and 133 had platelet reactivity recorded.
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Heart Attack Survivor Stories
BETTY B
“I am thankful for each day and the opportunities it brings to share my experiences with others.”
KEN L
“Ive changed my diet to minimize fat and salt. Im learning to read labels and make healthy choices.”
CINDY B
“It all comes down to listening the cardiologists listening to us, and not just with their stethoscopes and us listening to the cardiologists. Without both of these, there are no winners!”
RANDY W
“I now take a low dose Bayer Aspirin regimen, and I was told that the aspirin I was given during my heart attack helped save my life! Thanks for being there for me Bayer!”
Why Take An Aspirin While Waiting For The Paramedics
A heart attack, also called;myocardial infarction, is usually a form of;acute coronary syndrome;. ACS is triggered by the rupture of a;plaque;within a;coronary artery. This plaque rupture causes a thrombus to form within the artery, leading to a blockage. The portion of the heart muscle being supplied by the artery then begins to die. The death of heart muscle is what defines a myocardial infarction.
What this means is that, at the time you are having a heart attack, a big part of the problem is the growth of a blood clot within the affected artery. Formation of this blood clot depends to a large extent;on the blood platelets, which are tiny blood cells whose job is to participate in blood clotting.
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Aspirin Therapy In Heart Disease
For more than 100 years, aspirin has been used as a pain reliever. Since the 1970s, aspirin has also been used to prevent and manage heart disease. The American Heart Association recommends baby aspirin for “those at risk of heart attack and for those who have survived a heart attack”. The Food and Drug Administration , however, believes that aspirin should only be taken by patients who have heart disease or a history of heart attack or stroke. The FDA states that taking aspirin creates a risk of bleeding that outweighs the benefits of taking aspirin for people who do not have a history of heart attack or stroke.
Talk to your doctor first before taking aspirin. The following facts are meant to help you talk to your doctor about whether aspirin therapy is right for you.