Question of the Week 6_9

Answer: Studies have not proved that taking an aspirin at any age will in any way prevent a heart attack or stroke.

As for a "best" dose, that would be 325 mg. of coated aspirin, however, we strongly recommend you take it only if it has been prescribed by a doctor.

Most doctors will only prescribe daily aspirin if you have heart disease or multiple risk factors, such as smoking, high blood pressure, a family history of heart disease, or high cholesterol.

Editor's Note: I frequently recommend aspirin to my middle-age patients (male and female) who have at least one risk factor for coronary artery disease. This is based on previous evidence from the U.S. Physician's Health Study and Nurses Health Study that low-dose aspirin significantly decreases the incidence of first heart attack in men and women. (There have also been some observational studies that have shown an association between aspirin use and a reduction in the incidence of colon cancer).

According to the Clinician's Handbook of Preventative Services-1994, the American Academy of Family Physicians and the U.S. Preventative Services Task Force stated that low-dose aspirin therapy should be considered for men aged 40 and over who are at significantly increased risk for a heart attack and who lack contraindications to the drug.

As the following article from the Morbidity & Mortality Weekly Report 1997; (46(22): 498-502) shows, there are a lot of people taking aspirin despite conclusive proof it will work for them. Aspirin therapy is not without some risk and it's use should be individualized.

I agree with Dr. Short that the best course of action is to consult your physician first.

Charles H. Booras, MD

June 6, 1997

A high percentage of healthy adults are taking aspirin regularly to lower their risk of heart attack and stroke, despite a lack of conclusive proof it will work for them, government health officials report.

Surveys conducted in Wisconsin and Michigan show nearly one-quarter (23%) of men and women say they regularly take aspirin for that reason.

The new findings also suggest aspirin use in healthy individuals is more common among the health-conscious and physically active.

But aspirin's benefits for reducing the risk of a heart attack or fatal stroke have been demonstrated mainly in terms of "secondary prevention" - specifically, for men diagnosed with cardiovascular (heart and blood vessel) disease.

But despite a lack of solid evidence that aspirin's benefits also apply to women, the American Heart Association currently recommends that all persons with a history of heart attack or stroke, or who have other cardiovascular diseases, should take the drug.

In the late 1980s, a study showed that regular use of aspirin decreased the risk of heart attack by about half in healthy male doctors with no history of heart disease.

According to officials at the Centers for Disease Control and Prevention in Atlanta, Georgia, a body of national health experts (the U.S. Preventive Services Task Force, USPSTF) recommended in 1989 that doctors should consider regular low-dose aspirin for their male patients aged 40 and over who are "at substantially increased risk" for a heart attack and who lack contraindications to the drug - including stomach ulcers and allergy to aspirin.

Although the 1989 USPSTF guidelines were specific to high-risk men, the CDC says the surveys from the midwest "indicate that a high proportion of women (20.1%) report taking aspirin regularly despite the absence of any specific recommendations about prophylactic aspirin use in women."

"Some physicians may be prescribing aspirin for their female patients despite the USPSTF recommendations," the CDC states in a report released Thursday, "and some women may be deciding independently to initiate aspirin use."

According to the CDC, "the new study did not distinguish between aspirin use for primary or secondary prevention." But the agency states that the findings suggest that aspirin was used for primary prevention because the prevalence was higher among physically active people.

The survey results also show that aspirin use was higher among elderly men and current and former smokers, "suggesting that aspirin may have been used for secondary prevention," the CDC says.

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