After recently learning from Dr. Cohen’s
Cardiovascular Physiology class that some people take small daily doses of
aspirin as a protective mechanism in preventing myocardial ischemia from a
blockage in the coronary vessels, I wanted to research the side effects
associated with daily aspirin intake.
Aspirin is a Non-selective NSAID
(Nonsteroidal Anti-inflammatory Drug).
Non-selective means this particular drug inhibits both the COX-1 and
COX-2 enzyme. It is common for aspirin
to be taken daily by patients wanting to reduce their risks of cardiovascular
disease that includes conditions such as a myocardial infarction caused by an
arterial thrombosis or stroke. Aspirin prevents
platelet aggregation in the coronary vessels by inhibiting the COX-1 enzyme
that causes platelet activation and production by the eicosanoid, Thromboxane A2
(TXA2).
However, aspirin therapy is not for
everyone wanting to reduce their risks of a cardiovascular event because there
is a balance of risks and benefits that must be considered. Aspirin is associated with an increased risk
of bleeding in the gastrointestinal tract as well as in the brain, which can
lead to gastric ulceration with irritation to the protective lining of the
stomach and a hemorrhagic stroke, respectively.
Thus, the American Heart Association (AHA) does not recommend aspirin
therapy for people with an allergy to aspirin, people at risk for
gastrointestinal bleeding or hemorrhagic stroke, regular alcohol drinkers, and
users undergoing any simple medical or dental procedures because of aspirin’s
blood thinning properties which would lead to excessive bleeding.
Benefits against risks must be weighed
out for people considering low dosage long-term aspirin use. People should always consult with their
doctor before beginning their own aspirin therapy. Patients who are recommended for aspirin
treatment have a history of a cardiovascular related event, have high risk for cardiovascular
disease, have had coronary bypass surgery with a stent placed in a coronary
artery, or are a diabetic male over the age of 50 or a diabetic woman over the
age of 60. Individuals who do not fit
under these high risk categories should not start their own daily aspirin
therapy as a cardioprotective mechanism because the side effects of internal
bleeding far outweigh the benefits.
Sources:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Aspirin-and-Heart-Disease_UCM_321714_Article.jsp
http://www.mayoclinic.com/health/daily-aspirin-therapy/HB00073
Great post! I know a few people who take their daily dose of aspirin religiously, every morning along with their other multivitamins and supplements. I have also heard that it is good to take if you are in those high risk groups, but do you know if there is a dosage limit such one should take this amount everyday but more than that and the side effect increase? I found an article that said that a person should only take aspirin after they had already been diagnosed with cardiovascular disease and that it is not preventative but they also did not mention a dosage limit. I find it strange that this particular study they described contradicts what seems to be the majority of everyone else (those who take aspirin solely for preventative measures).
ReplyDeletehttp://www.health.harvard.edu/healthbeat/should-everyone-take-an-aspirin-a-day
Good questions Brynne. Well the logic is that you should ONLY take aspirin if you're at high risk for Cardiovascular disease and related events because of the association of GI bleeding with taking long-term aspirin which can lead to ulcers. The reason people with high risk or have had a cardiovascular event take aspirin is because the benefits of reducing the accumulation of platelets in their coronary vessels outweighs the risks of GI bleeding. The article you provided mentions this as well. From Cohen's Cardio lecture, she had mentioned that a baby aspirin a day of 80mg is cardioprotective against Coronary Artery Disease. However, people with diabetes where cholesterol is an issue in clot formation, they need to take an increased 325mg a day to reduce the stickiness involved in platelet accumulation. Therefore, if you're a healthy individual with no risks and no history of cardiovascular disease and are thinking of taking aspirin therapy, I would not recommend it as the risks outweigh the benefits.
ReplyDeleteIf you know someone who shouldn't be on daily aspirin, I recommend looking at this link below regarding any negative rebound effects that might occur if you completely stop aspirin therapy. Always ask a physician before starting your own drug therapy. Hope this helps! :)
http://www.mayoclinic.com/health/daily-aspirin-therapy/HB00073
Hello MaileenP495, I do want to point out that studies did show that only males did pose a significant benefit from use of aspirin in comparison to women. This can be mainly do to the greater thrombotic acitivity of men as well as the associated risk factors, as well as the presence of estradiol in women which is "clot-protective" at normal, physiolgical concentrations.
ReplyDeletehttp://bloodjournal.hematologylibrary.org/content/59/3/625.full.pdf
The debate still does arise on how much aspirin is good for the patient, mainly because clinicians noticed that there was a plateau of benefit and prevention even when there are dosage increases. Systematic reviews do point out that a dosage of approximately 75-81 mg is recomended as a preventative measure.
http://www.ncbi.nlm.nih.gov/pubmed/17488967
All in all, however, if there is an incidence of blood clots, doctors could utilize stronger pharmacological agents such as heparin, warfarin, tPA, or streptokinase. However, there was only a 70% success rate, according to Dr. Joseph Alpert, MD. Thus, they are given to buy enough time to get the individual into the catheterization lab. If the patient arrived at UMC or a hospital equipped with a cath lab, they would be immediately transported there for cardiac catheterization.
What individuals should be pursuing is lifestyle modifications, but even academic papers point out that these changes themselves have low compliance and consequential little long-term success.
It's interesting that you bring this up because too often have I seen on TV and on the news, that it is recommended for people to take antiinflammatories such as Aspirin and Ibuprofen as a daily supplement. The problem is that many people do not know the possible side effects that may result from taking these drugs too often. If you have to take them, they are a great medication, especially under the supervision/instruction of a physician. But when it is just announced on the news in their one to two minute news segment, it can be very misleading.
ReplyDeleteIn Michigan it was announced on the news to take Ibuprofen every day to prevent unnecessary inflammation that occurs in your body. They didn't mention anything about people who shouldn't take it, how much to take, or to even read the label to make sure this medication is safe for every individual to take. I wonder how many people actually followed this recommendation and actually did themselves more harm than good. Taking too much Ibuprofen can have serious side effects. I get head aches a lot, and every time the head ache is so bad that I have to take ibuprofen, I feel a bit uneasy and worried due to the side effects. I just cannot believe it was announced on TV to take it as a daily supplement, and it was announced as if its something normal and harmless.
Alex, the information you presented about males being the only sex to pose a significant benefit from the use of aspirin is very interesting. I didn't think of it on terms of sex differences. The article I had presented that reviewed COX inhibitors did not go into depth about how Aspirin as a Non-Selective NSAID varied their effects between male and females. However, I feel as if Aspirin would still be effective for either sexes as its beneficial property is the prevention of platelets aggregating.
ReplyDeleteDina, I think the reason for the overuse of drugs like Aspirin and Ibuprofen comes from these drugs having such a common presence in household medicine cabinets. They are both used so often for any need of pain relief that they seem like the "go-to" every day use pills. With many people having this idea, people don't see them posing such great threats since they can be bought just about anywhere without the need of a prescription. Unfortunately people do abuse these common household medications but people should always carry caution and read the labels of any medications they are or will take, as a student had mentioned in class about not knowing that her medication can increase risks for cardiovascular related events.
ReplyDeleteThis has been a very interesting discussion to read and I would like to comment on a few of your points regarding hearts attack risks between men and women as well as the possible misuse of NSAIDs.
ReplyDeleteThere is an interesting ongoing study since 1948 going on in Boston called the Framingham Heart Study. They have been comparing blood pressure, cholesterol, age, gender as well as other factors that may increase ones risk for a heart attack. The finding that I have found to be interesting has been in regards to gender. They have found that women who are in their reproductive ages are at the lowest risk of developing heart disease than men however once women reach menopause their risk becomes similar to that of mens. I find this quite interesting and definitely points to at least one advantage of producing estrogen :).
In regards to NAIDs usage, I have always wondered about infection risks while taking them? Or if the immune system is slow to react to a infection due to the anti-inflammatory effects of NSAIDs? I guess this has already been linked to an increased risk for toxic shock syndrome and others. So this is probably another reason people shouldn't take NSAIDs unless they really need them.
http://www.framinghamheartstudy.org/about/index.html
http://www.ncbi.nlm.nih.gov/pubmed/8645850
http://www.ncbi.nlm.nih.gov/pubmed/18251759
Interesting read and comments! I have heard some movement this year in the use of Aspirin for cancer prevention in addition to cardiovascular disease. A new review published this year indicates that information from clinical trials has recently shown support that aspirin is associated with decreased incidence of cancer. One meta-analysis shows a 20% reduction in 3-5 years and a 30% in post 5 years. the article carefully frames this in the context of the increased bleeding risk of cancer. This seems to support some of the material we have reviewed in class on onco-immunology, suggesting the links between cancer and the immune system. One other interesting point from this article was the lack of dose-response relationship. At "relatively low" doses of aspirin, the effect was realized, and there was no increased benefit from increased dosage. I still think that system wide drug effects (like aspirin) are not the best answer as drug therapies.
ReplyDeleteMichael J. Thun, Eric J. Jacobs, Carlo Patrono. The role of aspirin in cancer prevention. Nature Reviews Clinical Oncology, 2012; DOI: 10.1038/nrclinonc.2011.199