Saturday, March 17, 2012

An aspirin a day keeps doctor away

Aspirin is the one drug I would take to a desert island with me. It costs two cents a day and its benefits are amazing. And if it had no side effects at all, we could give it to everybody.
(Mark Fendrick, MD, University of Michigan Medical School)

Aspirin Discovery

Felix Hoffmann, a chemist at Bayer & Co., discovered aspirin by chance in 1897. He combined acetic and salicylic acids to create acetylsalicylic acid in a chemically stable form.

Scientists at Bayer realized they had identified a drug that reduced fever, relieved pain and had anti-inflammatory properties. By 1915, it was available without prescription as a tablet used primarily for joint, back and neurological pain.

Aspirin Benefits

In 1948, a family physician noted that 400 patients taking aspirin never had a heart attack and recommended an "aspirin a day" to reduce heart disease. And in 1988, a classic research study clearly showed that middle-aged men taking aspirin daily had a 40 percent reduction in heart attacks and a 32 percent reduction in all cardiac events.

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Later, aspirin was shown to reduce the risk of stroke and peripheral vascular disease as well as help treat high blood pressure.

Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, build up at the site of your wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.

But this clotting can also happen within the vessels that supply your heart and brain with blood. If your blood vessels are already narrowed from atherosclerosis — the buildup of fatty deposits in your arteries — a fatty deposit in your vessel can burst. Then, a blood clot can quickly form and block the artery. This prevents blood flow to the heart or brain and causes a heart attack or stroke. Aspirin therapy reduces the clumping action of platelets — possibly preventing heart attack and stroke.

Aspirin's benefits go beyond protecting the heart and brain. Everyone knows that aspirin is an excellent pain reliever and anti-inflammatory drug. But one of the most intriguing findings is aspirin's role in preventing cancer. In 2003, Dartmouth researchers reported that people taking a baby aspirin daily reduced their risk of precancerous polyps of the colon by 19 percent.

The anti-inflammatory effects of aspirin are believed to prevent damage to the lining cells of the colon, reducing cell abnormalities that can lead to polyps and cancer. And in a recent article published in the journal The Lancet, scientists in Great Britain evaluated 14,000 people who were taking low-dose aspirin for heart disease.

Taking 81 milligrams of (baby) aspirin daily reduced the risk of colon cancer by 24 percent and the risk of death from the cancer by 35 percent.

Aspirin impairs the function of an enzyme system called the cyclooxygenases (COXs). Two forms of the enzyme, COX1 and COX2, are inhibited by aspirin. The COX1 form is essential for normal platelet function and the integrity of the stomach wall. By inhibiting COX1, aspirin interferes with platelet function by reducing its ability to clump on arterial walls. In turn, this decreases the risk of a blood clot, heart attack or stroke. Unfortunately, it also increases the risk of damage to the stomach wall leading to pain, indigestion and a high risk of bleeding.

Aspirin's effects on the COX2 enzyme lead to less pain and a reduction in inflammation. Therefore, the analgesic effect of aspirin and its role on inflammation may be protective against cancer.

Aspirin Therapy Side Effects

What is truly remarkable is that the benefits occur as effectively when a baby aspirin tablet is taken daily as compared to larger doses, but side effects remain a concern. Even at a tiny dose, the drug can cause severe bleeding from the gastrointestinal tract, heartburn and indigestion. And some patients experience an allergic response that leads to asthma.

Aspirin is part of a family of medications called nonsteroidal anti-inflammatory drugs that include Motrin, Aleve and Celebrex. When used with these agents, the adverse effects of aspirin become more common and elevation of the blood pressure and declines in kidney function are significant risks.

Possible side effects and complications of taking aspirin include:
  • Hemorrhagic stroke. While daily aspirin can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (hemorrhagic stroke).
  • Gastrointestinal bleeding. Daily aspirin use increases your risk of developing a stomach ulcer. And, if you have a bleeding ulcer, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent.
  • Allergic reaction. If you're allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction.
  • Ringing in the ears (tinnitus) and hearing loss. Too much aspirin (overdosing) can cause tinnitus and eventual hearing loss in some people.

If you're taking aspirin and need a surgical procedure or dental work, be sure to tell the surgeon or dentist that you take daily aspirin and how much. Otherwise you risk excessive bleeding during surgery.

The Food and Drug Administration also warns that people who regularly take aspirin should limit the amount of alcohol they drink because of its additional blood-thinning effects and potential to upset your stomach. If you take daily aspirin therapy, you should not have more than two drinks a day.

Should you take a daily aspirin?

There is not ultimate agreement between the medical experts if the aspirin therapy is beneficial for EVERYONE (except for those, whose medical conditions do not permit), or it should be pursued ONLY for people who has elevated risk of heart disease and stroke. Most specialists appear to be in favor of daily aspirin consumption for all people after the certain age, claiming that the benefits far outweigh the possible complications.

For people with elevated risk of heart disease and stroke it is out of question. For them, the aspirin might become a lifesaver. Risk factors for a heart attack or stroke include:
  • Smoking tobacco.
  • High blood pressure — a systolic pressure of 140 millimeters of mercury (mm Hg) or higher or a diastolic pressure of 90 mm Hg or higher.
  • Total cholesterol level of 240 milligrams per deciliter (mg/dL) — 6.22 millimoles per liter (mmol/L) — or higher.
  • Low-density lipoprotein ("bad") cholesterol level of 130 mg/dL (3.37 mmol/L) or higher.
  • Lack of exercise.
  • Diabetes.
  • Stress.
  • Having more than two alcoholic drinks a day for men, one drink a day for women
  • Family history of a stroke or heart attack.

If you've had a heart attack or stroke, chances are your doctor has talked to you about taking aspirin to prevent a second occurrence.

If you have strong risk factors, but have not had a heart attack or stroke, you may also benefit from taking an aspirin every day. First, you'll want to discuss with your doctor whether you have any conditions that make taking aspirin dangerous for you.

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Health conditions conflicting with aspirin therapy

You shouldn't take a daily aspirin if you have some health conditions that could increase your risk of bleeding or other complications. These conditions include:
  • A bleeding or clotting disorder (bleeding easily).
  • Asthma.
  • Stomach ulcers.
  • Heart failure.

For people who have diabetes, the American Diabetes Association and other medical associations recommend a low-dose aspirin only for men older than 50 and women older than 60 who have at least one additional risk factor for heart disease, such as smoking, family history of heart disease, high cholesterol or high blood pressure.

It's also important to tell your doctor what other medications or supplements you might be taking, even if it's just ibuprofen (Advil, Motrin, others). Taking aspirin and ibuprofen together reduces the beneficial effects of the aspirin. Taking aspirin with other anticoagulants, such as warfarin (Coumadin), could greatly increase your chance of bleeding.

Dosage and General Guidelines

There provided recommendations are generic, and might be not applicable for your health conditions and family history. Please discuss with you family doctor.

General Guidelines:
  • Age to Start: Men should start a daily aspirin at age 45, mainly to protect against heart attacks. Women should start at 55, mainly to protect against stroke.
  • Age to End: And both sexes should stop by age 80, unless their doctors say otherwise. As you get older, there's a greater risk of bleeding in the brain or the digestive system -- a risk that is small but can be fatal in some cases.
  • Recommended Dose: There's no uniform dose of aspirin you should take to get the benefits of daily aspirin therapy. You and your doctor may specifically discuss what is right for you. Very low doses of aspirin — 75 milligrams (mg), which is less than a standard baby aspirin — can be effective. Your doctor may prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (regular strength). In most cases, 81 mg baby aspirin dose is applicable.
  • Brand: It is highly recommended to purchase only the brand-name medicine from Bayer ONLY as it has the best process control over the initial formula maintenance and purity of the components.

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Drug Interactions

Since both aspirin and ibuprofen reduce the clotting action of blood platelets, regular ibuprofen use can increase your bleeding risk. If you need only a single dose of ibuprofen, take it eight hours before or 30 minutes after the aspirin. If you need to take ibuprofen more often, talk to your doctor about medication alternatives that won't interfere with daily aspirin therapy.

If you're already taking an anticoagulant such as warfarin (Coumadin) for another condition, combining it with aspirin may greatly increase the risk of major bleeding complications. However, there may be some conditions for which combining a low dose of aspirin with warfarin is appropriate (for example, with certain types of artificial heart valves for secondary stroke prevention), but this therapy always needs to be carefully discussed with your doctor.

Medications that can interact with aspirin include:
  • Warfarin (Coumadin)
  • Heparin
  • Ibuprofen (Advil, Motrin, others), when taken regularly
  • Corticosteroids
  • Some antidepressants (clomipramine, paroxetine, others)
  • Taking some dietary supplements can also increase your bleeding risk. These include:
  • Danshen
  • Dong quai
  • Evening primrose oil
  • Ginkgo
  • Omega-3 fatty acids (fish oil)
  • Policosanol
  • Willow bark

Sources and Additional Information:

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