Doctor’s Tip: Should you take aspirin or not?
It always amazes me when patients say they don’t want to take any medication, but yet they are taking daily aspirin because they heard it might be a good thing to do, without knowing the pros and cons. The answer to whether one should take aspirin is not simple, but here it is:
Aspirin (salicylic acid), in the form of willow bark extract, has been used for thousands of years for pain, fever and inflammation, and has been available in pill form since 1897. It is also in many fruits and vegetables, with the highest concentration being in herbs and spices, particularly chili powder, paprika, and turmeric.
Aspirin from any source acts as an anticoagulant and helps prevent a blood clot from forming when atherosclerotic plaque (“hardening of the arteries”) ruptures, blocking off the blood supply, causing a heart attack or stroke. Aspirin also helps prevent several forms of cancer, particularly colorectal, stomach and esophageal (less clearly prostate, breast and lung).
However, just because something is “natural” doesn’t mean it can’t have side effects. The downside of aspirin is that it can cause brain hemorrhage (hemorrhagic stroke), stomach ulcers and life-threatening stomach bleeding. And some people are allergic to aspirin. If you do take aspirin, you should take only a baby aspirin (81 milligrams), because an adult aspirin (375 mg) is associated with a much higher rate of side effects.
There is general agreement among medical experts that if you have had a cardiovascular event (heart attack, atherosclerotic stroke), you should take 81 mg of aspirin a day to help prevent another event, as long as you don’t have a contraindication such as history of an ulcer or stomach bleeding.
For the rest of us, organizations such as the U.S. Preventative Task Force, the American Heart Association and the American Diabetic Association each have their own recommendations, all of which are based on the risk of having a cardiovascular event in the next 10 years. And they keep changing their recommendations, which means that they don’t really know what’s best. If you want to read more about “the party line” on aspirin and heart health, go to tinyurl.com/aspirinWL. For more about aspirin and cancer, see tinyurl.com/aspirinWL2.
Here’s what the experts whom I respect the most say: Brad Bale, M.D., and Amy Doneen, FNP, PhD, in their book “Beat the Heart Attack Gene,” feel the 10-year risk score mentioned above is bogus, and I would agree. They want to know what your arteries look like, and to determine that they order a carotid IMT or a coronary calcium score.
If you have atherosclerosis, you are at risk for a cardiovascular event and you should take a daily 81 mg aspirin if you don’t have contraindications. If your arteries are clean, the risk outweighs the possible benefit.
Furthermore, they point out that 30 percent of Americans have aspirin resistance, meaning 81 mg a day is causing risk but providing no benefit. This can be measured by a simple, $20 test, which unfortunately few providers recommend. If you are shown to be aspirin-resistant, you need to be taking a higher dose of aspirin, or possibly another anticoagulant such as Plavix (some people have resistance to Plavix as well, which can be determined by a genetic test).
Michael Greger, M.D. (nutritionfacts.org) looks at this a different way. In his recent book, “How Not to Die” (from cardiovascular disease, cancer, etc.) he asks, wouldn’t it be nice if there were a way we all could take daily, low-dose aspirin to help prevent cardiovascular events and cancer, without having the potential side effects? Well, there is, but it’s in the form of the produce mentioned in the second paragraph, rather than a pill. You might ask why there are no side effects from the salicylic acid in plants, and the answer is that “in plants, the salicylic acid appears to come naturally prepackaged with gut-protective nutrients, such as nitric oxide that boosts blood flow and protective mucus production in the lining of the GI tract.”
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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