Aspirin, the ageless remedy?

Article Abstract:

Willow bark contains salicylates, the group of chemicals that includes aspirin; the pain-killing properties of willow bark were known to Hippocrates and to the American Indians. However, the modern history of aspirin begins in 1763 when Reverend Edward Stone reported to the Royal Society the effect of willow bark on fever. Aspirin is acetylsalicylic acid, which is more digestible than salicylic acid derivatives. It first became available in 1899, and not only has aspirin persisted in its usefulness since that time, its uses have increased. Aspirin now seems to be something of a miracle drug. In the early 1970s, it was found that aspirin blocks the production of prostaglandins, important participants in the inflammatory response. This effect on prostaglandin synthesis also inhibits the aggregation of platelets; this function has proved to be of great value in treating heart disease. Platelet aggregation may occur at the broken edges of an atherosclerotic plaque in a blood vessel of the heart. Such aggregation may lead to the formation of a blood clot, which may then block the artery, leading to a heart attack and perhaps death. It is for this reason that daily aspirin is now included in the treatment of many patients who are recovering from a heart attack. In the October 31, 1991 issue of The New England Journal of Medicine, researchers report on the effects of different doses of aspirin among patients who have suffered a transient ischemic attack (TIA) or a nondisabling stroke. These events are powerful indications of heart disease; many patients will subsequently suffer major strokes or possibly fatal heart attacks. Researchers found that 30 milligrams (mg) per day of aspirin, roughly 10 percent of the normal dose, was as effective as a 283 mg dose in preventing heart attacks and strokes. The lower dose also caused fewer side effects. Even though successful results were obtained with a lower dose, it is still important to realize, and to emphasize to patients, that aspirin is a powerful drug and not to be taken lightly. As more people become aware of the beneficial effects of aspirin, it seems likely that physicians will begin to see greater numbers of uncommon but serious side effects such as bleeding from cerebral aneurysms and the development of allergy to aspirin. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke

Article Abstract:

Many strokes and heart attacks begin with the formation of a blood clot at a site where the endothelial lining of an artery has been injured. For this reason, aspirin, which inhibits clot formation, has been successful in reducing the rates of heart attacks and stroke among patients at high risk. One of the most significant risk factors for heart attack or stroke is a transient ischemic attack (TIA) or a ischemic stroke with no disabling consequences. Among such patients, the risk of a major and potentially fatal heart attack or stroke is between 7 and 12 percent per year. It has been established that this risk can be reduced by 20 to 25 percent by the daily use of aspirin. However, the best dose of aspirin has not been conclusively established. The average dose of aspirin that is currently used to prevent these cardiovascular events is about 300 milligrams (mg) per day. However, a 30 mg dose will inhibit the aggregation of platelets that prompts clot formation just as well as the 300 mg dose. Furthermore, since the larger aspirin dose also inhibits some favorable responses of the endothelial cells, the lower dose of aspirin might actually be more effective. A major study was conducted to determine the relative effectiveness of two different doses of aspirin. A total of 3,131 patients who had a TIA or minor stroke were randomly assigned to receive either 30 mg aspirin per day or 283 mg per day. After an average follow-up of two years, 14.7 percent of the patients receiving 30 mg aspirin daily had a stroke, a heart attack, or died from vascular causes. In the group taking the larger dose, 15.2 percent had similar events over the same period. Major bleeding complications that required hospitalization were slightly less frequent in the lower-dose group. Minor bleeding events were significantly less common in the lower-dose group, affecting 49 patients, in contrast with 84 patients in the other group. The results of this study indicate that the lower dose of aspirin is as effective as the higher dose and has fewer adverse side effects. Since the lower dose of aspirin requires more time to establish protective amounts in the blood, the authors recommend starting with 120 mg of aspirin per day and then lowering the daily dosage to 30 mg. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration

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Vitamin E supplementation and cardiovascular events in high-risk patients

Article Abstract:

Vitamin E does not appear to lower the risk of heart attack or stroke in patients with heart disease. Researchers randomly assigned 9,541 patients with cardiovascular disease or diabetes to take vitamin E or a placebo for an average of 4.5 years. There was no difference between the two groups in the number of heart attacks, strokes, death from cardiovascular disease, or death from any cause.

Vitamin E

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