CityView Magazine

CityViewNC.com | 63 Your Health By Lenny Salzberg, M.D. TAKE ASPIRIN... & CALL 2 MORNING THE IN ME A fter graduating from medical school on May 26, 1988, I came to Fayetteville to begin my residency training. On July 1, my first day as a doctor, I was called to the Emergency Department at Cape Fear Valley Hospital to evaluate a patient for admission in the Intensive Care Unit: a 45-year-old teetotaler who was vomiting blood. "Do you take anti-inflammatory medications, aspirin or aspirin-containing products, like Alka Seltzer?," I asked him. "No, no, no," he answered. "And you drink no alcohol or alcoholic beverages?" "Correct," he replied. But this man had a bleeding ulcer. Why? The mystery was solved when my supervising resident asked him if he ever used Goody's or BC's. "Just every day," he answered. He didn't know that Goody's and BCs were aspirin powders, and neither did I! On January 28, 1988, a full six months before this patient encounter, there was a special report in the New England Journal of Medicine regarding findings from the aspirin component of an ongoing study. The Physicians Health Study, begun four years earlier and scheduled to run through 1990, was stopped two years early due to the extreme beneficial effects of aspirin. The rates of heart attacks in the group taking aspirin were so much lower than the rates in the control group that it would have been unethical to not give aspirin to everyone being studied. So this begs the question: at what point does the benefit outweigh the risks? How much aspirin should you take? Is this true for both men and women? Aspirin has been around forever. In 400 BC, the Greek physician Hippocrates (of the Hippocratic Oath fame) prescribed willow bark to relieve pain and fever. After the active ingredient from willow bark was identified in the 1830s, aspirin (acetylsalicylic acid) was formulated from this in the 1890s by a chemist searching for relief for his father's arthritis pain. Aspirin quickly became the most commonly used drug worldwide for relief of pain, swelling and fever. Available as regular strength 325 mg. tablets, low strength "baby aspirin," and as various powders it is now used for treatment and secondary prevention of heart attacks and strokes. As of March 2009, the United States Preventive Services Task Force (USPSTF) encourages men age 45 to 79 to use aspirin for primary prevention of heart attacks when the potential benefits of a reduction in myocardial infarction outweigh the potential harm of an increase in gastrointestinal (GI) hemorrhage. The risk of GI bleeding with and without aspirin increases with age. Men have twice the GI bleeds of women. Non-steroidal anti-flammatory (NSAID) drug use (e.g. Motrin, Aleve, Ibuprofen, etc.) quadruples the risk for serious bleeding compared with aspirin alone. I am now a 45-year-old teetotaler with only one small risk factor for heart attacks (cholesterol issues.) I don't take NSAIDS, I don't have upper GI pain, and I have no history of a GI ulcer. For each thousand men like me between the ages of 45 and 59, taking aspirin each day for one year is estimated to cause eight extra GI bleeds, and one extra hemorrhagic stroke. Taking aspirin daily for that same year will prevent 19 heart attacks. I now take baby aspirin (81mg) every day. It's easy, it's inexpensive, and I'd rather have a small increase in one kind of risk in exchange for a big decrease in a scarier kind of risk. Why do I take a baby aspirin rather than an adult aspirin? The risk for GI bleed goes up with higher dosages of aspirin, but the benefit seems to be the same for as little as 81 mg. and possibly even lower doses of aspirin. The risk/benefit ratio is different for women, who shouldn't consider aspirin for primary prevention until age 55, and then we're looking at a stroke prevention rather than heart attack prevention. CV

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