FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

AN ASPIRIN A DAY CAN HELP HEART, BUT IT'S NOT FOR EVERYONE

Question: I know that people who are at risk of having a heart attack should consume the equivalent of a baby aspirin every day. What about those of us who are naturally built with a propensity (short and wide) to heart disease yet are still young? Is there a risk to taking a small dose of aspirin daily?

Answer: Aspirin has certainly proven its worth in reducing the risk of a second heart attack. It has also shown its value in preventing a first heart attack for those who have had the type of heart pain doctors call "angina" or who have undergone a previous coronary angioplasty. 

Reducing the risk of heart disease is certainly very important since it's the leading cause of death for both men and women in our country. The numbers are staggering -- at least 500,000 individuals die every year of a heart attack and another 500,000 from other types of heart disease. Obviously, anything that can reduce these numbers is a significant advantage for the individual, their loved ones and for society in general. 

It only takes 30 milligrams of aspirin each day to reduce the risk of a second heart attack and to offer benefit for those who have specific risk factors for a first one. This surprisingly small dose is equal to one-tenth of a normal aspirin tablet every day. I suppose you could just keep an aspirin on your nightstand and give it one good lick before turning in each night. That would give you the necessary 30 mg. Because this isn't very practical, most of us recommend taking one aspirin every other day or one baby aspirin each day. 

Unfortunately, aspirin is not without the potential to cause health problems. Stomach pain, heartburn, ulcers, constipation and bleeding from the digestive tract are common complications. Not surprisingly, those who take ten tablets each day are more likely to have these problems than are those who take a half a tablet. Even small amounts, though, still increase the risk of complications compared to swallowing a similarly sized pill with no active ingredients (placebo). 

With this background on aspirin risks, I can now address the heart of your question (pardon the pun!). Should someone with a risk factor such as body shape -- but no history of heart disease -- take a daily small dose of aspirin? Well, the U.S. Preventive Services Task Force guidelines don't offer any guidance. They say, "There is insufficient evidence to recommend for or against routine aspirin prophylaxis for the primary prevention of myocardial infarction (MI) in asymptomatic persons." 

Let me put this medical "bureaucratese" in plain English. If you have no history of previous stomach or bleeding problems, then taking an aspirin every other day has a low risk of causing you harm. It becomes your choice, but do talk to your doctor about it. The story of aspirin's benefits doesn't stop with heart disease, however. There is some data that suggests it may reduce the risk of colon cancer and Alzheimer's disease. I hope that within the next few years research will clarify the answer to your question in a much more definitive way so that we can identify who among us will benefit from taking aspirin as a preventive measure. 

Finally, you should be aware that while taking an aspirin a day may be beneficial, attention to other risk factors is likely to be more important for the health of your heart. Check your blood pressure, cholesterol and blood sugar. Keep these in the normal range by diet and medicine if necessary. Exercise regularly to promote cardiovascular fitness. And the most important thing you should do to reduce your risk of heart disease is (drum roll please) eliminate the use of any tobacco products.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.