Cardiovascular disease (CVD) refers to a group of conditions that affect the heart, brain and blood vessels. The American Heart Association reports 81.1 million Americans (more than one-third the population) have one or more forms of cardiovascular disease. Some of the most common types are high blood pressure (74.5 million), coronary heart disease (17.6 million), heart failure (5.8 million) and stroke (6.4 million).
Cardiovascular disease is the leading cause of illness-related death in the U.S. Researchers say it’s the underlying or contributing cause of 58 percent of deaths in this country.
An Aspirin a Day
Aspirin (acetylsalicylic acid) is a drug originally produced from the leaves and bark of the willow tree. The active ingredient is a substance, called salicin.
Use of aspirin’s active ingredient dates back to ancient times, when Hippocrates used the leaves and bark of the willow tree to treat pain and fever. The first usable form of aspirin was created by Friedrich Bayer and Company in 1897 and made available to prescribing physicians in 1899. By 1915, aspirin became available in a tablet form and was made available as an over-the-counter drug. Today, aspirin is used to treat fever and pain, headaches, menstrual cramps, arthritis and muscle aches.
During the 1970s, scientists discovered that aspirin inhibits the production of natural chemicals, called prostaglandins, which are involved in the development of inflammation and the formation of blood clots. Ten years later, researchers found aspirin use could potentially reduce the risk for a recurrent heart attack in patients with a heart attack history. The drug also proved to reduce the risk for a future heart attack in patients with unstable angina (chest pain caused by narrowed coronary arteries). The benefit of aspirin is related to the drug’s ability to keep the blood thinned and prevent the development of blood clots that could block the flow of blood to the heart muscle. Since then, aspirin has also been shown to reduce the risk of ischemic stroke (one caused by a clot) in patients with a prior history of stroke.
The U.S. Preventive Services Task Force (USPSTF) currently recommends aspirin therapy for men aged 45 to 79 who are at risk for a new or recurrent heart attack, and for women 55 to 79, who are at risk for a new or recurrent ischemic stroke. Aspirin does carry an increased risk for bleeding (because it reduces the ability of the blood to clot). So patients who have risk factors for bleeding should discuss the risks and benefits of aspirin therapy with the health care providers. Aspirin is also generally not recommended for people who have an allergy to aspirin or salicylates or patients with asthma, uncontrolled high blood pressure, severe liver or kidney disease or bleeding disorders.
Aspirin for Seniors?
The benefits of aspirin therapy are well established for patients who are in middle- to late middle-age. However, the usefulness in older patients isn’t yet known. An ongoing study, called ASPREE (Aspirin in Reducing Events in the Elderly) aims to determine if aspirin has the same life-prolonging effects in healthy patients over 70. In addition to cardiovascular disease, researchers will look at the effects of aspirin on functional disability, dementia, cancer and bleeding.
Study participants will be randomized to take a daily dose of either a 100 mg of enteric-coated aspirin or a placebo for 5 years. An initial assessment involves a medical history, blood pressure measurement, blood tests, medications used and lifestyle questions. Memory and thinking skills will also be assessed. A follow-up assessment is done at six months, then annually starting one year after enrollment. During the follow-up visits, researchers will assess blood pressure, medical history, medication use, lifestyle, weight, height, waist circumference, general health, daily activities, memory and thinking, walking and hand grip strength.
The ASPREE study is a Phase IV clinical trial and needs to recruit thousands of healthy participants age 70 and older. For more information, go to http://www.clinicaltrials.gov, then type the trial identification number in the search box: NCT01038583. Information is also available from the study’s website at http://www.aspree.org.
AUDIENCE INQUIRYIf you have any questions about taking aspirin to prevent cardiovascular disease, talk with your family health care provider. For information about the ASPREE Study, go to http://www.clinicaltrials.gov, then type the trial identification number in the search box: NCT01038583. Information is also available from the study’s website at http://www.aspree.org
For information about aspirin: Food and Drug Administration, http://www.fda.gov
For general information about cardiovascular disease:
American Heart Association, http://www.heart.org
National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov
BIBLIOGRAPHY“Aspirin for the Prevention of Cardiovascular Disease,” Annals of Internal Medicine, March 17, 2009, Vol. 150, No. 6, pp. 396-404.
“Aspiring in the Primary and Secondary Prevention of Vascular Disease,” The Lancet, May 30, 2009, Vol. 373, No. 9678, pp. 1849-1860.
Calvin, Andrew, M.D., et al., “Aspirin for the Primary Prevention of Cardiovascular Events,” Diabetes Care, December 2009, Vol. 32, No. 12, pp. 2300-2306.
Cleland, John, et al., “Long-Term Aspirin for Coronary Artery Disease,” Future Cardiology, March 2010, Vol. 6, No. 2, pp. 141-146.
Wolff, Tracy, M.D., et al., “Aspirin for the Primary Prevention of Cardiovascular Events,” Annals of Internal Medicine, March 17, 2009, Vol. 150, No. 6, pp. 405-410.