It costs pennies a pill-but for heart disease and stroke, the number one and number three killers of Americans, aspirin can be just as powerfully preventive as more expensive medications, such as cholesterol-lowering statins.

Two-thirds of people at high risk for heart attack and stroke don't take aspirin daily-leading to an estimated yearly death toll of 45,000 people who might have lived if they had taken a low-dose aspirin every day. And recent evidence shows that aspirin also plays a role in fighting colon cancer and possibly other diseases…

Protecting Diseased Arteries

If you've had a heart attack, taking aspirin daily reduces your risk for a second attack by 23%. If you have angina-chest pain that signals serious heart disease-daily aspirin reduces heart attack risk by 51%. Type 2 diabetes -which damages arteries, increasing risk for heart attack and stroke-is another reason for daily aspirin. Taking aspirin if you have diagnosed heart disease or are at high risk for heart disease due to type 2 diabetes is called secondary prevention-it's too late to prevent the problem, but you're controlling it.

What to do: If you have heart disease or type 2 diabetes, talk to your doctor about aspirin therapy. The recommended dosage for secondary prevention is 81 milligrams (mg) daily, or one "baby aspirin." There continues to be debate about whether 162 mg daily may be more protective for some people with heart disease or diabetes-ask your doctor.

Preventing Heart Attack

In March 2009, the US Preventive Services Task Force (USPSTF) recommended the daily use of aspirin for primary prevention-preventing heart attack and stroke in people who don't have diagnosed cardiovascular disease.

Because older age is a risk factor for heart attacks and strokes, the recommendation included all men between the ages of 45 and 79 and all women between the ages of 55 and 79.

Among these groups, the USPSTF said to use aspirin for primary prevention only in cases in which the benefits are likely to outweigh the risks. When aspirin blocks the production of blood-clotting thromboxane, it increases the risk for internal bleeding.

The benefits of taking aspirin are likely to be greater than the risks in those with an elevated risk for heart attack and stroke. These risk factors include high total cholesterol, lower than normal HDL (good) cholesterol, high blood pressure, smoking and older age.

Factors that may indicate aspirin is too risky for you include…

  • Recent bleeding from a stomach ulcer or hemorrhagic stroke, caused by a ruptured blood vessel.
  • History of gastrointestinal (GI) bleeding caused by other nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Taking an anti-inflammatory corticosteroid, such as prednisone.
  • Rheumatoid arthritis.

Age 80 Or Older

The USPSTF didn't include a recommendation for people age 80 or older, because there's not enough scientific evidence to know whether aspirin protects this age group. However, your risk for heart attack and stroke increases with age, so those over 80 are likely to benefit from aspirin, but they also are more likely to have GI or brain bleeding.

What to do: If you're 80 or older, ask your doctor about taking aspirin. You probably shouldn't take it if you have a history of GI bleeding or falls (a head injury is more likely to cause hemorrhagic stroke in someone taking aspirin).

Colon Cancer

A study by researchers at Harvard Medical School published in The Journal of the American Medical Association showed that people with colorectal cancer who began taking aspirin regularly after diagnosis had a 29% lower risk of dying from the disease than those who never used aspirin. Researchers also found that those who used aspirin regularly before their diagnosis had a 61% lower risk of dying from the disease. Aspirin reduces inflammation, which may play a role in the progress of colon cancer.

What to do: If you've been diagnosed with colorectal cancer, talk to your doctor about taking aspirin. There is not enough scientific evidence to justify taking aspirin to prevent colorectal cancer.

Using Aspirin Wisely

  • Don't worry about the formulation. In most cases, aspirin doesn't cause GI bleeding because it irritates your GI tract--the bleeding is caused by a systemic effect on COX (see the explanation that follows). That means enteric-coated tablets don't decrease the risk for GI bleeding.
  • Be cautious of blood-thinning supplements. Fish oil and the herb ginkgo biloba also affect platelets, increasing the risk for internal bleeding. If you're taking aspirin, talk to your doctor about whether it's safe to be taking those supplements.
  • Don't take aspirin and another NSAID at the same time. Recent research shows that NSAIDs, such as ibuprofen and naproxen (Aleve, Naprosyn), interfere with aspirin's abil. ity to affect COX. If you take another NSAID, take it four to six hours before or after taking aspirin.
  • Think twice about stopping aspirin before surgery. Surgeons often ask patients to stop taking aspirin about two weeks before surgery. But if you take aspirin for secondary prevention, the risk for a heart attack may outweigh the risk for additional bleeding during surgery. Ask your physician.
  • If you think you're having a heart attack, call 911 immediately and take aspirin. Chew an uncoated full-strength (325-mg) aspirin right away. Taking aspirin once a day for the next month can reduce the risk for death by 23% and may significantly reduce damage to the heart.

How Aspirin Works

Aspirin is acetylsalicylic acid-a compound A that blocks the action of cyclooxygenases (COX), enzymes that are found in every cell.

COX help manufacture prostaglandins, hormones that are involved in pain, fever and inflammation. COX also help produce thromboxane, which allows cells in the bloodstream called platelets to stick together, forming blood clots.

By impeding prostaglandins, aspirin lowers fever, relieves acute pain such as headache, and eases the soreness that accompanies inflammation. By reducing thromboxane, aspirin helps stop the formation of blood clots, reducing the risk for a heart attack and stroke.

Ouch! Naproxen Raises Ulcer Risk

In a new study of 56,515 adults, those who I took low-dose (500 milligrams daily) naproxen (Aleve)-a nonsteroidal anti-inflammatory drug-were 25 times more likely to be hospitalized due to complications from gastric or intestinal ulcers (such as stomach bleeding) than those who did not take the drug.

If you take over-the-counter naproxen: Do so sparingly. If your doctor prescribes naproxen, ask whether you should also take a drug, such as esomeprazole (Nexium) or omeprazole (Prilosec), to reduce ulcer complications.

Stomach-Acid Drugs Raise Food-Poisoning Risk

Medicines that lower production of stomach acid, such as Prevacid and Prilosec, can increase food-poisoning risk by reducing the acid that is the body's natural defense.

Self-defense: If you use these drugs, be especially careful when handling raw meat and poultry, and avoid foods associated with food poisoning, such as raw oysters, raw eggs and unpasteurized milk.

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