Aspirin Therapy Revisited

Cardiovascular Care

Nov 21
Young doctor offering aspirin

This is something we’ve talked about at this site [The Dangers of Aspirin, 2002], but new information from recent studies has forced us to take a closer look at Aspirin Therapy. The latest studies/conclusions on aspirin therapy will be at the bottom of this article. 

When Aspirin Therapy first came about, it was aimed simply at keeping platelets from sticking together, or clotting. With the recent revelations that CVD (cardiovascular disease) and most heart attacks are actually the result of inflammation, Aspirin Therapy became even more popular because aspirin is an anti-inflammatory.

There is quite a bit of concern over the action of aspirin, acetylsalicylic acid; whether it is the actual chemical makeup that prevents blood from clotting, or whether it’s the ingredient that aspirin is “buffered” with that prevents the clotting.

Here is the actual science, put into understandable terms:

Aspirin inhibits an enzyme that makes the body synthesize specific prostaglandins that cause inflammation and other prostaglandins that cause platelets to get sticky and form clots. [J. Scientifc Exploration 2000:14(4):623-641]

There have been hundreds of studies showing the efficacy of aspirin therapy preventing heart attacks by preventing clotting. Aspirin does not “thin the blood;” it merely prevents clotting.

What most of the studies don’t tell you is that the studies used buffered aspirin, and it is now thought that the calcium and magnesium in the buffering pretty much contributed to the positive outcome in all these studies. In fact, the article (above) points out: “Supplemental magnesium and vitamin E have been shown to be more effective than aspirin in lowering heart attack rates as well as overall death rates.”

Editor’s Note: Were I asked if I could recommend only one supplement for cardiovascular wellness, what would it be? My answer would be magnesium. Click the link to see the exact brand (the store from which I get it) I use.

Excuse the digression, but I, like most people, like to bounce around WebMd once in a while to get their take and I discovered this:

NSAIDs reduce inflammation and relieve fever and pain by blocking enzymes and proteins made by the body. NSAIDs such as ibuprofen and naproxen block a protein (called prostaglandin) that makes heavy menstrual bleeding worse. Aspirin does not block this protein.”

We just published (above): “Aspirin inhibits an enzyme that makes the body synthesize specific prostaglandins that cause inflammation and other prostaglandins that cause platelets to get sticky and form clots. [J. Scientifc Exploration 2000:14(4):623-641]”

I left them a note that in 1982, John R. Vane was awarded the Nobel Prize for showing exactly how aspirin inhibits the enzyme cyclooxygenase, preventing the cells of the body from making certain prostaglandins. [Nobel Prize dot Org]

Everyone makes mistakes. Make no mistake about that.

Downside to Aspirin Therapy

There is a downside to aspirin therapy. Aspirin is classified as a Nonsteroidal anti-inflammatory drug (NSAID). And one thing we know about these drugs today is their continued use leads to CVD (cardiovascular disease) and heart attacks (myocardial infarction, or MI).

But I’m getting ahead of myself, because you should know that Naproxin and Aspirin are the two safest (as far as CVD is concerned) NSAIDs.

However, in 1998, aspirin and NSAIDs reportedly contribute to over 16,000 deaths each year, largely as a result of induced G.I. bleeding

A study published in 2005 produced the following:

The incidence of hospital admission due to major GI events of the entire (upper and lower) gastrointestinal tract was 121.9 events/100,000 persons/year, but those related to the upper GI tract were six times more frequent. Mortality rate was 5.57% (95% CI = 4.9-6.7), and 5.62% (95% CI = 4.8-6.8) in study 1 and study 2, respectively. Death rate attributed to NSAID/aspirin use was between 21.0 and 24.8 cases/million people, respectively, or 15.3 deaths/100,000 NSAID/aspirin users. Up to one-third of all NSAID/aspirin deaths can be attributed to low-dose aspirin use.

Calculating the totals using these figures in 2005 with the US population at 295.5 million, there were 360,215 events due to NSAIDS and 45,212 deaths.

Now we should already be aware of the fraud perpetrated upon the public concerning cholesterol and statin drugs. Cholesterol does not cause heart disease; eating saturated fat does not cause heart disease; and taking statin drugs won’t prevent heart attacks. In fact “A meta-analysis of 50 cholesterol-lowering interventions, including diet, resins and lovastatin, lowered cholesterol levels an average of 10%, but there was a 1% increase in overall mortality.” [J. Scientifc Exploration 2000:14(4):623-641]

Saying that LDL Cholesterol is bad because it ends up on your arteries is like saying that rain is bad because it causes floods.

In other words, more people died using the cholesterol lowering drugs than in the control group.

In fact, here is a flyer advertising Lipitor along with a paragraph “blown up” from the ad. As you can see, Lipitor will not protect you from a heart attack.

And get this:

A meta-analysis of trials of calcium channel blockers, even tho they really do lower blood pressure, showed possibly harmful effects overall. In addition, two new antiarrythmia drugs approved by the FDA, encainide and flecainide, clearly suppressed arrythmias, probably as seen by electrocardiograms, as the surrogate endpoint. However, it was found that 3 times as many patients in the drug group died as in the placebo group. [J. Scientifc Exploration 2000:14(4):623-641]

Because of known problems with aspirin therapy, the recommendation, from conventional medicine and alternative medicine, is a smaller dosage. A famous study known as PHS 89 used the magical dosage of 81mg per day with a meal.

Were there problems with the study? Well, fewer heart attacks, but more hemorrhagic strokes, and in the end, the people on the aspirin died at the same rate as the control group.

In other words, the people on aspirin died from other things, other than heart attacks, so there was no upside to using aspirin.

And the really striking observation here is that in 2009 a study was published in the article: Aspirin does more harm than good in healthy people: research, that came to the conclusion that “for healthy people taking aspirin does not significantly reduce the risk of a heart attack.” And that, “At the same time they found it almost doubles the risk of being admitted to hospital due to internal bleeding.”

Thus the newer studies are not telling us anything new when they point out that there’s another downside to aspirin that has recently come to light (recently as 2009, apparently). If you’re going in for surgery, doctors recommended their patients on aspirin therapy quit taking aspirin about a month or so prior to the surgery. After surgery, you’ll want your blood to clot to help heal all that damage the scalpels cause.

There was one huge problem noted in these people quitting their aspirin a day therapy: half of them died before the operation. You had a 50% chance of a heart attack before the surgery if you quit taking an aspirin a day.

Doctors are now re-thinking this advice, but for brain surgery, you have to be off of your anti-clotting meds because the simplest bleed can kill you.

Or, let’s face it; you could always take a little magnesium and a good vitamin E daily.

And now the most recent information started coming out a few years ago, when a Dr Orr from the Royal College of Surgeons (England) performed a cohort study [cohort means “a group of people;” their medical histories help researchers point to causes and risk factors; see Studies Show] that went like this:

Software was used to analyze 10,000 patients registered with a large primary care facility who fit the following profile:

  • Over 50 years old.
  • Had been prescribed NSAIDs in the past.
  • Was previously diagnosed with ischemic heart disease, diabetes mellitus and/or hypertension.

And their findings?

  • Heart failure risk was roughly doubled by all NSAIDs.
  • All NSAID regimens increased upper gastrointestinal complications.
  • Major vascular events were increased by about a third by a coxib [Cox-2 inhibitor], chiefly due to an increase in major coronary events.
  • Ibuprofen also significantly increased major coronary events, but not major vascular events.

By “All NSAID regimens” is meant, aspirin too. And this is contrary to the accepted position. Aspirin is supposed to protect against major coronary events. [Aspirin and ibuprofen proven to cause heart attacks; Note that this is not the original article we pointed to, which referenced half a dozen studies. Sadly, it’s vanished from the internet. This one will have to do for now.]

In England around the turn of the century, they performed an RCT [Randomized Controlled Trial] using three groups in what was known as the Wafarin/Aspirin Study in Heart Failure (WASH). Each of the 279 subjects had experienced either a heart attack or a stroke brought on by thrombosis (a blood clot).

As we said, they were divided into three groups: one got a standard dose of Wafarin, one got 300 mg of aspirin, and the third group got a placebo.

Over two years later, follow up uncovered that neither the aspirin nor the Wafarin provided any greater protection against nonfatal strokes, nonfatal heart attacks, or death than the placebo. And in the group taking aspirin, they were twice as likely to suffer a heart attack or stroke as those who took Wafarin (or the placebo). And then there are the usual gastrointestinal problems associated with aspirin prompting Dr John G F Cleland, the lead researcher in the study to proclaim that theoretical benefits of aspirin be damned, because the real evidence points to it just doing harm.

And finally, a Taiwan cohort study looking at medical records of around 60,000 people discovered that people with high blood pressure who went on a regimen of one of the following NSAIDS, etodolac, nabumetone, ibuprofen, or naproxen, increased significantly their chances of a stroke or heart attack. [Ref]

Now Hear This

Most recently this has come to light: If you have an upper respiratory infection, such as a cold or flu, taking aspirin therapy could bloody kill you.

Yes, taking an aspirin or any NSAID when you have a cold (or upper respiratory infection such as the flu) triples your risk of a heart attack. And it’s even higher (seven times higher than with no cold or flu) if the painkiller is taken intravenously.

The study, first published in the Journal of Infectious Diseases, was conducted at by Dr Cheng-Chung Fang, MD who examined nearly 10,000 patient records of those who had been hospitalized for a heart attack over a six year period. [Common pain relievers may increase heart attack risk during respiratory infections]

As we’ve pointed out a few times in our research, it’s very hard to prove causation. Correlation is not causation, and causation is very difficult to “prove” in medicine.

However, these results have moved physicians to reconsider their prescribing habits, and take into consideration more factors when prescribing NSAIDS for acute respiratory infections.

And, if I could prescribe, I’d suggest a good magnesium and a good vitamin E complex with mixed tocopherols and mixed tocotrienols, and no synthetics to keep your blood from forming dangerous clots. Or you could take a look at our article: Nutrients and Supplements for Preventing and Reversing Cardiovascular Disease for supplements that inhibit platelet aggregation that can form clots.

And never forget that inflammation is at the root of cardiovascular disease, followed by high blood pressure. They both cause plaque buildup and our recommendations have always been:

Update 2/8/19

Do not take an aspirin a day if you are healthy.

Published in JAMA, 2019; 321: 277-87, we now know that, in healthy people, the risks outweigh and advantages of aspirin therapy. King’s College London discovered that aspirin reduced the risk of CVD by just 11%, but raised the risk of bleeding by 43%. And they found no evidence that this practice reduced the risk of cancer. 

Update 8/2/19

Over 70? Stop aspirin therapy unless you’ve suffered a heart attack.

This advice is from the American Heart Association, and up till recently, they wanted everyone on aspirin. But studies are showing that, again, the risks outweigh the benefits. We learned from the Annals of Internal Medicine, 2019; doi: 10.7326/M19-0953, that a substantial number of people over 70 are self-medicating with aspirin, and not telling their doctors. Of course, we’re all flooded with aspirin commercials on TV that try to convince us that your daily, low dose aspirin is saving lives, but that’s advertising, not reality or studies. 

What are the actual numbers? 

  • 29 million over 40 took an aspirin a day even though they did not have heart disease (CVD, or Cardiovascular Disease). 
  • Half of those over 70 with no history of CVD took an aspirin a day.

And over one third of these did so without telling their doctors.

Update 10/28/19

Never take aspirin if you’ve never had a heart attack.

From the Canadian Family Physician [2019; 65: 480], we learn that everything we thought we knew about aspirin in the nineties was based on flawed science. After reviewing three major studies, researchers at the University of Alberta concluded that, again, and we emphasize again, that the risks outweigh the benefits. And it just wasn’t due to the risk of bleeding; it seems these people were dying at a higher and significant rate from cancers. 

Our advice? Get proper sleep, go for walks at least three times a week, eat an anti-inflammatory diet, and supplement with proper vitamins and anti-inflammatories (that you can read about here in what one of our proofreaders called, a Russian novel: Chronic Inflammation).

Further Reading (if you haven’t read them already):

Dangers of Aspirin

Hypertension (High Blood Pressure)