Friday, May 16, 2014

Daily Aspirin To Prevent First Heart Attack Does Not Get FDA Backing

Does aspirin prevent heart attacks
Tuesday, May 6, 2014 (Medical News Today)

The FDA says while there is evidence that low-dose aspirin can prevent heart attacks, strokes and cardiovascular problems reoccurring (so-called secondary prevention), the case has yet to be made for using it to prevent a first event (primary prevention).

Aspirin works by interfering with the blood’s clotting action, so reducing the chance of clots developing and obstructing flow of oxygen and blood. Clots that obstruct a coronary artery can cause heart attacks, while blockages in the blood supply to the brain are a cause of stroke.

D. Robert Temple, FDA’s deputy director for clinical science, says for people who have not had a heart attack, stroke or cardiovascular problems, “the benefit has not been established but risks – such as dangerous bleeding into the brain or stomach – are still present.”

Neither does the data support the use of aspirin to prevent heart attack or stroke in people who have never had them but have a family history of them or are showing evidence of arterial disease, the report adds.
However, large trials looking at the use of aspirin in primary prevention of heart attack and stroke are ongoing, and the FDA will continue to monitor them and update consumers should the evidence change.

“The bottom line is,” say the FDA, “that in people who have had a heart attack, stroke or cardiovascular problems, daily aspirin therapy is worth considering.”

Aspirin was first marketed by the Bayer Company in 1897. It was developed to mimic the effects of White Willow Bark, an herb used to reduce inflammation. Salicylic acid was thought to be the active ingredient in White Willow Bark, so Bayer combined acetone (think nail polish remover) with citric acid to create aceto-salicylic acid – aspirin.

In wasn’t until 1994, when the chemical pathways for Aleve and Advil were discovered, that aspirin’s chemical pathway was also unraveled. It turns out, that the acetone is a Cox 2 inhibitor just like Aleve and Advil. The salicylic acid is not responsible for the anti-inflammatory effects in aspirin or White Willow Bark.

Subsequent research into White Willow Bark has failed to identify what chemical compounds account for its anti-inflammatory effects. Although it is often effective, I seldom use it as I want to know what chemical pathways I am affecting with treatment.

Aspirin, Aleve, and Advil cause over 16,000 deaths each year in the US. Most of the victims are over the age of 60 and less than a third has any warning signals. Most of them die from GI bleeds, but liver failure and heart attacks are the second and third most common form of death. By the way, the reference in this article to “bleeding in the brain” is called a bleeding stoke, so aspirin can cause strokes as well.

Daily aspirin does not really prevent heart attacks, strokes or pulmonary embolisms. It does however; reduce the risk of damage if such an event does occur. So there is some merit to its use.

Indiscriminate use of aspirin, Aleve, or Advil can be fatal. Please discuss the use of these drugs with your physician. Look for contraindications and drug interactions with any other prescription drugs. If you have not had a heart attack or stroke, even with a strong family history, aspirin is probably not for you.