Table of contents:

1. Aspirin and its anticoagulant effect
2. When does aspirin help?
3. What to replace aspirin with in primary prevention?
4. Summary

Is aspirin really such a heart-saving drug? Unfortunately, recent studies contradict the common belief that taking aspirin can protect against, among other things, a heart attack.

Important! If you have a healthy heart and take aspirin prophylactically - you are damaging your health. A study of 95,000 people showed that such prophylaxis can result in internal bleeding.

Prof. Jill Belch of the University of Dundee in Scotland, who conducted a study for eight years on the effects of aspirin intake in diabetics - confirms the above thesis. Prof. Belch is of the opinion that diabetics with a healthy heart should discontinue this type of thromboprophylaxis (this applies to people over 50 as well as those with hypertension). In the opinion of the scientist, a more effective form of thromboprophylaxis for this group of people would be, among other things, exercise, quitting smoking and a proper diet.

Important! Aspirin or other drugs containing acetylsalicylic acid should be taken by people with known coronary artery disease, whose risk of heart attack is greater than 10-15%.

Aspirin and its anticoagulant effect

Aspirin is a non-steroidal anti-inflammatory drug. It is the first drug to be obtained by chemical synthesis (this event took place in 1897). The medicine has very variable effects depending on the dose. At higher doses (250 to 500 mg), it is usually associated with analgesic, anti-inflammatory and antipyretic activity; At lower doses (75 to 100 mg) - aspirin has an effect on reducing the likelihood of heart attack and stroke.

Advances in molecular technology, as well as the intensive development of biotechnology, made it possible to discover (1960s) that acetylsalicylic acid, in addition to its analgesic effect, among other things, also has the ability to inhibit platelet aggregation (the deposition of platelets on the walls of blood vessels).

Important! Aspirin inhibits platelet aggregation and the formation of clots in blood vessels.

The anticoagulant effect of acetylsalicylic acid is due to its ability to inhibit the activity of an enzyme (cyclooxygenase). By blocking this enzyme, the production of thromboxane (a special substance that glues platelets together) in platelets is inhibited. The presence of thromboxane causes an intensive process of platelets sticking together and adhering to the arterial wall as an increasingly massive thrombus. Complete closure of the coronary artery lumen by the platelet thrombus can lead to an infarction.

The beneficial effect of aspirin in inhibiting blood vessel clots has been reported for a long time. However, as mentioned above, the studies carried out show that this drug is only beneficial to health under certain conditions.

When does aspirin help?

Does aspirin really have a beneficial effect on the prevention of cardiovascular disease? According to Professor Stefan Grajek, Head of the 1st Department of Cardiology at the Medical University of Poznań, this drug is not suitable for primary prevention.

- If someone has not had overt clinical symptoms of atherosclerosis and has not had a heart attack or stroke, taking aspirin only exposes them to an increased risk of haemorrhagic complications, but does not give them a significant reduction in these complications, and this is what aspirin is taken for," the specialist points out, and adds: - Effectiveness of primary prevention - none, safety - highly stretched. On the other hand, if someone is taking aspirin after documented atherosclerotic disease, which has been subjected to various procedures (e.g. by-pass), then there secondary prevention cannot be imagined without aspirin.

According to Prof. Grajek, aspirin abuse leads to an increase in mortality through haemorrhagic complications and through sudden aspirin withdrawal after long-term aspirin use. Two weeks after aspirin withdrawal, in cases where the patient has been taking aspirin for more than a month, this causes what is known as 'rebound syndrome' in the body (the return of symptoms that disappeared or were under control while taking the drug but appeared when the drug was discontinued or the dose was reduced) and clotting suddenly drops. A patient who decides to use aspirin must already be taking it continuously. As Prof Grajek believes, primary prevention therefore does not pay off - secondary prevention pays off.

What can be substituted for aspirin in primary prevention?

The best substitute for the drug is an appropriate diet with a minimum of saturated fats and a maximum of fruit and vegetables. In addition, it is important to be physically active (sport) and, above all, to reduce serum LDL cholesterol levels. According to Prof Grajek, the rationale for using aspirin in primary prevention was the hope of preventing the development of atherosclerotic plaque. However, in order to realise this postulate, the other arm of atherosclerosis pathogenesis must be hit - lipids. Lowering LDL cholesterol offers prevention of atherosclerosis. Not by the platelet-blocking route, as aspirin does, but by the cholesterol-lowering route. The professor adds that great hopes lie in innovative therapies supported by so-called PCCH9 inhibitors (LDL-C-lowering drugs).

Summary

According to specialists, there is no need to stop taking aspirin. However, in any doubt, the patient should consult a doctor. The use of the drug is essential in patients with clinically diagnosed atherosclerosis. In these cases, even if there is an increased likelihood of haemorrhagic complications, its use is recommended, as it reduces the risk of atherosclerotic complications such as heart attack or stroke.