The origin of Aspirin can be traced to Hippocrates. He had advised his followers to chew the leaves of the willow tree to alleviate pain. The Chinese have been using the bark of the same trees — which contain salicin — to control fever. In the early 1800s, different derivatives of this bark were tested and one — acetylsalicylic acid, the chemical name for Aspirin — was found to be tolerated better than the others. It even finds a mention in Ayurveda as a multi-purpose medication.Aspirin can realistically be called a wonder drug because of the many remedial effects it can have on the human body. Basically, it interferes with the production of a series of chemicals — called prostaglandins — that regulate many of the body’s vital functions.By blocking certain prostaglandins, Aspirin lowers body temperature, relieves minor aches and pains, relieves inflammation and interferes with the role of blood platelets in forming clots. It is this last effect that appears to impact on the risk for heart disease. How does this work?Blood clots are formed by platelets grouping together. Aspirin interferes with this process by making the platelets less “sticky” — and therefore less successful in grouping together — by inhibiting the manufacture of prostaglandins.This same blood “thinning” action that makes Aspirin effective in reducing a person’s risk for heart disease is also the reason why some people are unable to take the drug. Although it is over a century old and being used as a home remedy for several ailments, its use to prevent heart attacks, strokes and related illnesses has been scrutinised scientifically in several evidence-based large studies in the last 20 years. Used appropriately, it is one of the most cost-effective drugs in treating and preventing heart and vascular diseases. For heart angina, heart attack, strokes and related illnesses Aspirin reduces mortality if taken as soon as possible after a heart attack and unstable angina (acute coronary syndrome). The reduction in mortality varies from 15 to 20 per cent, according to various studies.Once begun, it is to be taken on a long-term basis under medical supervision. It is mostly combined with several other drugs to maximise benefit.All patients with chronic stable angina also need this drug lifelong to prevent heart attack. In this situation, it is one of the several measures to improve the long-term survival.Likewise, in many forms of stroke associated with clot formation in brain, the drug is extremely useful in limiting the extent and progression. It is, however, very important to investigate the cause of an acute stroke by a CT head or a MRI evaluation to rule out bleeding as the cause. Aspirin can cause aggravation of the stroke if the cause is a cerebral bleed.Prevention of heart attack and stroke in high-risk population Patients at a high risk are those who have multiple risk factors: Diabetics, patients with a previous blockages of arteries, high cholesterol levels, those with family history of blockages in arteries, chronic smokers etc.As per epidemiological studies, any person with a 10-year risk of getting a heart attack or a stroke of more than 10 per cent will benefit from taking Aspirin regularly. This will mean all diabetics over 35 years in age and any person with two or more of the above-mentioned risk factors. Since Aspirin always is not an innocuous agent, it should always be taken under medical supervision in these situations.How much aspirin and for how long?In general, 75 mgs of Aspirin per day is an effective dose for its heart protective effect. In this low dose, efficacy is maintained and the side effects on stomach are minimised. The drug is to be taken on a long term, usually life long, to reduce the risk of vascular events that increase with age. Enteric coated or buffered preparations are not necessarily safer.Patients taking painkillers like Ibuprofen frequently run a higher risk of side effects. Individuals on blood thinners like Warferin also need to exercise caution in taking Aspirin because of increased bleeding risk.Other painkillers like Paracetamol, Acetaminophen, Ibuprofen do not posses the beneficial cardio- protective properties of Aspirin.What else should you be doing?First, talk with your doctor to see if you need aspirin therapy. If you’re a cigarette smoker, have uncontrolled high blood pressure, or are diabetic or overweight, get these problems under control. Stop smoking. Have a healthy diet, exercise, and reduce your stress. That way, you’ll not only reduce your risk for a heart attack, you’ll strengthen your overall health. And that can only improve your life and longevity.The author is Director, Escorts Heart Institute, New Delhi Facts to remember• Aspirin is a very useful drug for preventing heart attacks and strokes• Daily use of Aspirin is not right for everyone• Daily Aspirin can be safest when prescribed by a medical health professional • Once your doctor decides that daily use of Aspirin is good for you, safe use depends on following the directions
