I was recently reading a medical article that reviewed the discussion about aspirin use for prevention of cardiovascular disease. The somewhat controversial debate has been taking place about this issue throughout my professional career.
To be clear, it is well-established that aspirin is an important medication for the prevention of cardiovascular events, such as heart attack and stroke in people who have already experienced one of these events. This is called secondary prevention.
The controversy arises regarding the routine use of aspirin among people without known cardiovascular disease who wish to prevent a first event. This is known as primary prevention, and the practice was quite common about 10 years ago. However, in the interval, the medical evidence has been less supportive of it.
Aspirin is derived from a substance commonly found in plant varieties such as the willow tree. It has actually been in use for well more than 100 years. It is known to be an effective fever-reducer and pain reliever. Its use has generally been restricted to adults based on the finding that use in children carries the risk of Reye’s Syndrome, which may cause damage to the brain and liver.
Aspirin is a member of the family of medication known as nonsteroidal, anti-inflammatory drugs. As such, frequent or excessive use has been associated in some instances with stomach ulcers, as well as harmful liver and kidney effects, particularly in people with pre-existing chronic health conditions involving the gastrointestinal system or kidneys.
It is partly this issue of ulcers that influences recommendations about aspirin use for prevention of heart attack and stroke. Another unique property of aspirin is that it thins the blood, reducing blood-clot formation. While this is the beneficial property from a cardiovascular disease standpoint, it also increases the associated risk of gastrointestinal bleeding.
For some experts, the decision about whether to recommend aspirin for primary prevention of cardiovascular disease is a balance between vascular disease risk factors (such as diabetes or high blood pressure) and risk of bleeding. Yet, some studies in recent years have called into question the value of aspirin for primary prevention in general.
The good news is that several important studies are underway to try to resolve this question. Two of these include the ASCEND trial (A Study of Cardiovascular Events in Diabetes) and the ASPREE study (Aspirin in Reducing Events in the Elderly).
Also, the U.S. Preventive Services Task Force is in the process of updating its recommendations about aspirin.
What is clear is that all people should seek advice from their medical provider before making a decision about aspirin use for prevention.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.