Spring 2004
Ask the Expert : Heart and Aspirin

I´ve been reading that an aspirin a day can help prevent a heart attack. I´ve never had a heart attack, and I don´t want to have one! Should I be taking an aspirin a day, and if so, what´s the correct dose?

Gilead Lancaster, MD, medical director of Non-Invasive Cardiology in the Heart Institute at Bridgeport Hospital, responds:

Aspirin keeps the platelets (cells in your blood stream) from clumping together. This, plus aspirin´s anti-inflammatory effect, helps to keep blood clots from forming and blocking the heart arteries.
Gilead Lancaster, MD

By now it has been well established that taking a daily dose of aspirin can reduce the chances of a sec-ond heart attack or stroke in people who have already had their first-and that aspirin can help prevent first heart attacks and strokes in those who are at risk.

But that doesn´t mean that daily aspirin is right for everyone. If you´re young, healthy, have no risk fac-tors and no family history of heart disease, the risks of daily aspirin (such stomach bleeding, bleeding in the brain, kidney failure, and certain kinds of strokes) outweigh the benefits. You should ask your physician whether aspirin therapy is right for you.

Who Could Benefit from Daily Aspirin?

People whose physicians may decide that aspirin therapy is beneficial include-

Angina sufferers and heart attack survivors
Stroke survivors, if the stroke was caused by a blood clot (as opposed to having a blood vessel burst or leak)
Diabetics older than 30
People with peripheral vascular disease
Patients who have recently had coronary bypass surgery or stents
People with coronary artery disease or atherosclerosis
People with major risk factors for heart disease (high blood pressure; high levels of cholesterol, triglycerides, homocysteine or C-reactive protein; and/or a family history of heart attack).

Who Should Not Take Daily Aspirin?

People who should probably not take aspirin daily include the following:

Those who are allergic to aspirin
People with uncontrolled high blood pressure
People with any bleeding disorder (hemophilia, von Willebrand´s, etc.)
Those with peptic ulcers
Anyone with liver or kidney disease
People who suffer from gastrointestinal bleeding
Those who are taking anticoagulants (blood thinners) such as Warfarin (Coumadin), unless aspirin is added by a physician for patients needing more blood thinning.

What´s the Right Dose?

If your physician decides that aspirin therapy is right for you, he or she will prescribe the correct dosage. The recommended dose for cardiovascular use is generally 50 to 325 milligrams once daily. Many physicians prescribe one or two baby aspirin (81 milligrams apiece). Doses higher than 325 milligrams a day may actually be less effective than the lower doses, and should be avoided.

Don´t make the mistake of thinking that any pain reliever will have the desired effect. Only aspirin (acetylsalicylic acid) will do the job. Acetaminophen (Tylenol™, etc.) is not known to be effective. And ibuprofen (Motrin™, etc.) not only won´t help prevent heart attacks, but taken along with aspirin, it is known to reduce aspirin´s beneficial heart effects.

For a referral to an expert physician, call Bridgeport Hospital Physician Referral, 24/7,
at 888-357-2396. English/Spanish.

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