Should We All Take Aspirin to Prevent Heart Disease?

Michael Greger M.D. FACLM · December 7, 2016 · Volume 33

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The benefits of taking a daily aspirin must be weighed against the risk of internal bleeding.

Discuss

Transcript

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Salicylic acid, the active ingredient in aspirin, has been used for thousands of years as an anti-inflammatory painkiller in the form of willow tree bark extract, which Hippocrates used to treat fever and to alleviate pain during childbirth. It became trademarked as a drug in 1899, and remains, to this day, probably “the most commonly used drug in the world.” One of the reasons it remains so popular, despite the fact that we have better painkillers now, is that it also acts as a blood thinner. Millions of people now “take aspirin on a daily basis to treat or prevent [heart] disease.”

It all started back in 1953, with the publication of this landmark study in the New England Journal of Medicine: “Length of Life and Cause of Death in Rheumatoid Arthritis.” The paper started out with the sentence: “It has often been said that the way to live a long life is to acquire rheumatism.” They found fewer deaths than expected from accidents—which could be explained by the fact that people with arthritis probably aren’t out, you know, going skiing—but, also, significantly fewer deaths from heart attacks. Maybe, it was all the aspirin they were taking for their joints that was thinning their blood, and preventing clots forming in their coronary arteries, in their heart. And so, in the 1960s, there were calls to study whether aspirin would help those at risk for blood clots. And, in the 1970s, we got our wish—studies suggesting regular aspirin intake protects against heart attacks.

Today, the official recommendation is that low-dose aspirin is recommended for all patients with heart disease. But, in the general population, for those without a known history of heart disease or stroke, daily aspirin is only recommended when the heart disease benefits outweigh the risks of bleeding.

The bleeding complications associated with aspirin use may be considered “an underestimated hazard in clinical [medical] practice.” For those who’ve already had a heart attack, the risk/benefit analysis is clear. If you took 10,000 patients, daily low-dose aspirin use “would be expected to prevent approximately 250 major vascular events”—such as heart attacks, strokes, or, the most major event of all, death. But, that same aspirin would be expected to cause approximately 40 major extracranial bleeding events—meaning bleeding so bad you have to be hospitalized.

“Thus, the net benefit of aspirin for secondary prevention”—meaning like preventing your second heart attack—”would substantially exceed the bleeding hazard. For [every] 6 major vascular events prevented, [only about] 1 major bleeding event would occur.” So, “the value of aspirin for secondary prevention is not disputed.”

But, if you instead took 10,000 patients who had never had a heart attack or stroke—yet—and tried to use aspirin to prevent clots in the first place (so-called primary prevention), daily low-dose aspirin would only be expected to prevent seven major vascular events, at the cost of causing a hemorrhagic stroke (bleeding within the brain), along with three other major bleeding events.

So then, the benefits are only like two to one, which is a little too close for comfort—which is why the new European guidelines do not recommend aspirin for the general population, especially given the additional risk of aspirin causing smaller bleeds within the brain as well.

If only there were a safe, simple, side effect-free solution. And, there is. Ornish and Esselstyn proved that even advanced crippling heart disease could not only just be prevented and treated, but reversed, with a plant-based diet, centered around grains, beans, vegetables, fruits, with nuts and seeds treated as condiments—and no oils, dairy, meat, poultry, or fish.

Bill Castelli, long-time director of the longest running epidemiological study in the world—the famous Framingham Heart Study—was once “asked what he would do to reverse the [coronary artery disease] epidemic if he were omnipotent. His answer? ‘Have the public eat the diet…described by Dr. T. Colin Campbell.” In other words, he told PBS, if Americans ate healthy enough, “the whole [heart disease epidemic] would disappear.” Though, Esselstyn clarifies, we’re not just talking about vegetarianism. “This new paradigm” of heart disease reversal means “exclusively plant-based nutrition.”

Please consider volunteering to help out on the site.

Sources

Acknowledgements

Image credit: stu via flickr. Images have been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Salicylic acid, the active ingredient in aspirin, has been used for thousands of years as an anti-inflammatory painkiller in the form of willow tree bark extract, which Hippocrates used to treat fever and to alleviate pain during childbirth. It became trademarked as a drug in 1899, and remains, to this day, probably “the most commonly used drug in the world.” One of the reasons it remains so popular, despite the fact that we have better painkillers now, is that it also acts as a blood thinner. Millions of people now “take aspirin on a daily basis to treat or prevent [heart] disease.”

It all started back in 1953, with the publication of this landmark study in the New England Journal of Medicine: “Length of Life and Cause of Death in Rheumatoid Arthritis.” The paper started out with the sentence: “It has often been said that the way to live a long life is to acquire rheumatism.” They found fewer deaths than expected from accidents—which could be explained by the fact that people with arthritis probably aren’t out, you know, going skiing—but, also, significantly fewer deaths from heart attacks. Maybe, it was all the aspirin they were taking for their joints that was thinning their blood, and preventing clots forming in their coronary arteries, in their heart. And so, in the 1960s, there were calls to study whether aspirin would help those at risk for blood clots. And, in the 1970s, we got our wish—studies suggesting regular aspirin intake protects against heart attacks.

Today, the official recommendation is that low-dose aspirin is recommended for all patients with heart disease. But, in the general population, for those without a known history of heart disease or stroke, daily aspirin is only recommended when the heart disease benefits outweigh the risks of bleeding.

The bleeding complications associated with aspirin use may be considered “an underestimated hazard in clinical [medical] practice.” For those who’ve already had a heart attack, the risk/benefit analysis is clear. If you took 10,000 patients, daily low-dose aspirin use “would be expected to prevent approximately 250 major vascular events”—such as heart attacks, strokes, or, the most major event of all, death. But, that same aspirin would be expected to cause approximately 40 major extracranial bleeding events—meaning bleeding so bad you have to be hospitalized.

“Thus, the net benefit of aspirin for secondary prevention”—meaning like preventing your second heart attack—”would substantially exceed the bleeding hazard. For [every] 6 major vascular events prevented, [only about] 1 major bleeding event would occur.” So, “the value of aspirin for secondary prevention is not disputed.”

But, if you instead took 10,000 patients who had never had a heart attack or stroke—yet—and tried to use aspirin to prevent clots in the first place (so-called primary prevention), daily low-dose aspirin would only be expected to prevent seven major vascular events, at the cost of causing a hemorrhagic stroke (bleeding within the brain), along with three other major bleeding events.

So then, the benefits are only like two to one, which is a little too close for comfort—which is why the new European guidelines do not recommend aspirin for the general population, especially given the additional risk of aspirin causing smaller bleeds within the brain as well.

If only there were a safe, simple, side effect-free solution. And, there is. Ornish and Esselstyn proved that even advanced crippling heart disease could not only just be prevented and treated, but reversed, with a plant-based diet, centered around grains, beans, vegetables, fruits, with nuts and seeds treated as condiments—and no oils, dairy, meat, poultry, or fish.

Bill Castelli, long-time director of the longest running epidemiological study in the world—the famous Framingham Heart Study—was once “asked what he would do to reverse the [coronary artery disease] epidemic if he were omnipotent. His answer? ‘Have the public eat the diet…described by Dr. T. Colin Campbell.” In other words, he told PBS, if Americans ate healthy enough, “the whole [heart disease epidemic] would disappear.” Though, Esselstyn clarifies, we’re not just talking about vegetarianism. “This new paradigm” of heart disease reversal means “exclusively plant-based nutrition.”

Please consider volunteering to help out on the site.

Image credit: stu via flickr. Images have been modified.

Doctor's Note

More on preventing, arresting, and reversing heart disease in:

This is the first of three videos on the risks versus benefits of taking aspirin. Preventing heart disease and stroke are not the only benefits, though. A daily aspirin may also decrease the risk of certain cancers. In that case, should we take an aspirin a day, after all? See my next video, Should We All Take Aspirin to Prevent Cancer? And then, I end with Plants with Aspirin Aspirations.

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