| Aspirin and Athrosclerosis |
 |
 After decades of research, it is still unclear as to whether
aspirin can prevent the chances of an atherosclerotic event, even though
there has been many studies with immense bases.
The third meta-analysis from the Antithrombotic Trialists' Collaboration
contains data on over 100 000 patients at high risk of atherosclerotic events,
representing more than 250 000 patient years of follow up. This meta-analysis,
together with its 2 predecessors, forms the main argument for the widespread
recommendation of prescribing aspirin to these high-risk patients.
Till now, the results
are inconclusive.
Summary Points:
The choice of the Antithrombotic Trialists' Collaboration to advise aspirin
for patients at high risk of atherosclerotic events is arbitrary and suspect
since very few trials have actually managed to demonstrate the benefits
of antiplatelet agents. In fact, it seems that the antiplatelet agents
are more effective in reducing the incidence of non-fatal events, rather
than reducing the death rate itself.
The effects of antiplatelet agents can be threefold: by genuinely reducing
the rate of nonfatal events, by concealing them, or by converting non-fatal
events into fatal ones. Among other large long-term trials, there
is no evidence whatsoever that aspirin saves lives of patients after myocardial
infarction. This suggests that aspirin merely reduces
mortality rate by concealing vascular events, rather than actually preventing
them.
Epidemiological data suggest that 25% of nonfatal myocardial infarctions are silent.
As aspirin, even at low doses, is an analgesic and because it may provoke
dyspepsia, which may create confusion about the cause of chest pain, it
is not difficult to believe that aspirin could increase the proportion
of silent events from 25% to 30%. This could explain all the benefits
of antiplatelet agents on nonfatal myocardial in the meta-analysis.
Aspirin increased the risk of sudden death
in every long-term study after myocardial infarction that reported such
events.
 What you should know
Aspirin is not as good as it sounds, even at the baby aspirin dosage of
81 mg used every day or every other day. To prevent atherosclerosis,
one needs to concentrate on building the collagen matrix that improves elasticity
and repair vascular integrity. Aspirin is seldom needed to be used as a
blood thinner as there are better natural compounds such as vitamin E 400
to 800 I.U. and ginkgo biloba 120 mg.
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