Aspirin: Its role in cardiovascular disease prevention and first aid

Aspirin is an inexpensive way to improve the outcomes of heart attacks, as well as in aid in prevention. A new study of a Minnesota program shows that it could save millions of dollars, too.

Cardiovascular diseases (CVD) are the leading causes of death and disability in the United States, accounting for nearly one-third of all deaths. (1) According to the CDC, they are both costly and preventable. One of the solutions and preventive measures may be a simple as aspirin! This article will discuss this topic.

A new study published in the Journal of the American Heart Association has found that the University of Minnesota's "Ask About Aspirin" initiative, a statewide public health campaign, is possibly a favorable and cost-effective way to reduce the incidence of a first heart attack or stroke. (2) The study concluded that using current US Preventive Services Task Force recommendations, a state public and health professional awareness campaign would probably deliver clinical benefit and be economically sound. (2) With clinician judgement of individual benefit and risk, tools could be made available that would simplify success of aspirin's beneficial impact on lowering risk of primary CVD events, with minimization of adverse outcomes.

Since the 1980s, aspirin has been regularly used to prevent and treat heart disease and stroke as secondary prevention. (3) However, uncertainty remains regarding its role in primary prevention. In the public health arena, we must urge patients to have evidence‐based discussions with their health-care providers regarding prevention and treatment of disease. Providers must similarly acknowledge the importance of collaboration with their patients through shared decision making to deliver true patient‐centered care. (3)

READ MORE | What a difference an X makes: Sex differences in cardiovascular disease, stroke, and more

Remember there are sex-based differences in diseases and medications. Aspirin provides different benefits for men as compared to women. Primary prevention studies of have found that aspirin offers a relative risk reduction of myocardial infarction (MI) by 32% in men and 17% in women. In men, there was no effect on stroke or all-cause mortality; in women, there was no effect on MI or all-cause mortality. (4)

Aspirin use can be helpful as first aid for a heart attack. Calling 911 immediately and taking an aspirin if advised may be a critical step for early intervention that can limit organ damage. Aspirin helps by inhibiting blood platelets. (5) Only a small amount is needed to inhibit all the platelets in the bloodstream, and in fact small amounts are better than high doses. However, time is of the essence. A study was performed to determine the best way to take an aspirin in an emergency situation. One was by swallowing a tablet with 4 ounces of water; by chewing the tablet for 30 seconds before swallowing it; or by drinking 4 ounces of water with Alka-Seltzer. By all three measurements, chewed aspirin worked fastest at 50% efficiency in five minutes. (5)

READ MORE | Hype vs. evidence: Revisiting research regarding oral/systemic disease

Taking aspirin is not advised during a suspected stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots (ischemic stroke), but some are caused by ruptured blood vessels (hemorrhagic stroke). Taking aspirin could potentially make hemorrhagic strokes more severe. (6) Keep in mind that all medicines have side effects, and aspirin can cause allergic reactions, bleeding, and other side effects. You should not start aspirin therapy without first consulting your physician. The risks and benefits of aspirin therapy vary for each person.

Editor's note: This article originally appeared in RDH eVillage Focus. Our editorial team would be happy to deliver content like this to your inbox twice a month. Just let us know by subscribing here.

References
1. Chronic Diseases: The Leading Causes of Death and Disability in the United States. CDC web site. http://www.cdc.gov/chronicdisease/overview/index.htm. Updated Febraury 23, 2016. Accessed March 2, 2016.
2. Michaud TL, Abraham J, Jalal H, Luepker RV, Duval S, Hirsch AT. Cost‐Effectiveness of a Statewide Campaign to Promote Aspirin Use for Primary Prevention of Cardiovascular Disease. J Am Heart Assoc. 2015;4(12). pii: e002321.
3. Kim JH and Borden WB. Within‐the‐Clinic Shared Decision for an Over‐the‐Counter Medication. J Am Heart Assoc. 2015 Dec 23;4(12). pii: e002927.
4. Using Aspirin for the Primary Prevention of Cardiovascular Disease. June 2009. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/clinicians-providers/resources/aspprovider.html. Accessed March 2, 2016.
5. Aspirin for heart attack: Chew or swallow? Harvard Health Publications Family Health Guide. http://www.health.harvard.edu/heart-health/aspirin-for-heart-attack-chew-or-swallow. Published May 1, 2005. Updated October 9, 2015. Accessed March 2, 2016.
6. Types of stroke. CDC website. http://www.cdc.gov/stroke/types_of_stroke.htm. Updated December 6, 2013. Accessed March 2, 2016.