Humble aspirin helps save lives

The "humble" aspirin is one of the oldest drugs in the physician’s armamentarium. It is also one of the cheapest. Many health experts consider it as one of the most important cardiovascular drugs that can help prevent many heart attacks and strokes, and save many lives.

Unfortunately, aspirin is still massively underused, according to heart experts and a research published in the British Medical Journal.

Although well-known as a fever pill for its antipyretic effect, aspirin serves an even more important function as a potent antiplatelet, a blood thinner which prevents the blood elements, especially the platelets, from being sticky.

According to Dr. Ramon Abarquez Jr., professor emeritus at the University of the Philippines College of Medicine, sticky platelets lead to an "increased adhesiveness and aggregation" of these blood elements. When this happens, the blood tends to become thicker with a tendency to clot. This is compounded by changes in the blood vessels making their inner lining, the endothelium, also leaky.

Called endothelial dysfunction, these abnormal changes allow other blood elements to interact with the bad cholesterol circulating in the blood to seep beneath the endothelium and develop the atherosclerotic narrowing of the blood vessels. Hence, endothelial dysfunction is considered the precursor of atherosclerosis.

There are several risk factors which can make the platelets sticky and the endothelium leaky. The major ones are high blood pressure, diabetes, elevated cholesterol and smoking. When one has two or more of these risk factors, one may be considered to be at risk of developing atherosclerotic complications such as a heart attack and stroke.

"The good news though," says Abarquez, a past president of the Philippine Heart Association, Philippine College of Physicians and the Philippine Society of Hypertension, "high-risk patients can be helped to prevent these complications." He advises that these patients consult their physicians for proper evaluation and treatment.

Aspirin prevents the blood from clotting and blocking arteries which may lead to heart attacks and strokes. Previous studies show that aspirin (and other antiplatelet drugs) could prevent around 100,000 premature deaths worldwide every year.

As a result, aspirin is almost always prescribed to patients with a heart attack or unstable angina (chest pains), and is widely used for long-term protection by people who have had a previous heart attack or stroke.

A study funded by the British Heart Foundation (BHF<http://www.bhf.org.uk/> ) and the Medical Research Council (MRC<http://www.mrc.ac.uk/> ) strengthened the evidence that aspirin prevents heart attacks and strokes in a wide range of patients with high-risk conditions such as angina (chest pains), peripheral arterial disease (narrowing of the leg arteries) and diabetes.

But recent surveys in the United States and United Kingdom have shown that less than half of patients with high-risk conditions are prescribed aspirin. The researchers estimate that worldwide 40,000 more lives could be saved every year if everyone with a high-risk condition for whom aspirin was appropriate actually received it.

Dr. Colin Baigent, MRC scientist who led the research, said, "This study shows that aspirin is beneficial in an even wider range of conditions than previously believed. What we now need is to ensure that aspirin, or some other antiplatelet drug, is routinely considered for patients who might need it."

Baigent added, "Worryingly, surveys in the UK have shown that aspirin is currently prescribed to less than a quarter of people with diseases such as peripheral arterial disease – a condition which causes fatty deposits to build up in the leg’s arteries and in which heart attack and strokes are common."

"We believe that aspirin may well have helped protect these high-risk patients but sadly many will die from their very first heart attack – by which time aspirin is too late," he said.

The research team hopes that this report will help dispel any remaining uncertainty among doctors and lead to an increase in the prescribing of this effective and inexpensive drug.

Prof. Charles George, medical director of the British Heart Foundation, said; "These findings reinforce what we have known for some time, that aspirin is a life-saving treatment that will provide major benefits to many thousands of people at high risk of heart attack or stroke. Aspirin is not an appropriate treatment for everyone but it is important that all those who might benefit are actually offered it."

Cardiovascular diseases, as one category, are now the leading causes of deaths in the Philippines. It is expected that with an optimal use of aspirin, the incidence of heart attacks and strokes may be significantly reduced. A low dose of aspirin – 75 to 160 mg which may be obtained in one to two tablets daily of Aspilet – already gives an adequate antiplatelet effect with minimal side-effects. A tablet of Aspilet contains 80 mg of aspirin.

The humble aspirin is one of the most scientifically documented drugs. Several landmark studies attesting to its efficacy have been published and there are currently more than 80 ongoing studies evaluating its usefulness in preventing atherosclerotic complications in various types of patients and situations.

Because of its significant contribution to improving a heart patient’s cardiovascular outlook based on well-designed studies, it is endorsed by the American Heart Association, American College of Chest Physicians and the American Diabetes Association in the prevention of recurrent heart attack, stroke and heart-related deaths.

A subsequent landmark study, the Hypertension Optimal Treatment (HOT), published in the prestigious Lancet journal, showed that low-dose aspirin reduced major cardiovascular events by 15 percent and all cases of a first myocardial infarction (heart attack) by 36 percent.

Although low-dose aspirin (Aspilet) is an over-the-counter product, patients are advised to consult their doctor to see whether they are suitable candidates for aspirin therapy.