Doc Gurley is a Board-certified Internist physician and the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing. You have to give credit where credit is due – a recent analysis of studies looking at the benefits of aspirin therapy for people without a prior history of a heart attack managed to reduce the decision to a pretty simple bottom line: name your poison – a heart attack or puking up blood? We here at Doc Gurley really like this type of research – it translates a complex problem into something most people can get their heads around.
Researchers at Oxford looked at data regarding the benefits of daily aspirin for people without a prior history of heart attacks (no one’s questioning the benefits in people who’ve ALREADY had a heart attack – that’s very well established). Their analysis found that if you give a daily aspirin to a bunch of people who’ve never had a heart attack (95,000 in one study, 17,000 in another), you lower the risk for heart attack by
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about a fifth, but you increase the risk for vomiting up blood/having blood in your stools (GI bleed) by about a third. To be even MORE specific, for every 10,000 people taking aspirin, you prevent five nonfatal heart attacks, but get one extra bleeding-related stroke, and three extra gastrointestinal bleeds.
So what should you do if you’re shaking out a baby aspirin into your palm every morning and staring at it, wondering whether to take it or not? It’s a decision best made between you and your doctor, but – in general – for Doc Gurley, it boils down to the fact that gastrointestinal bleeds are very treatable – as long as they’re recognized. If you get black, tarry stools, or vomit up blood, or even puke up something that looks like coffee grounds – you should get to the hospital pronto and, usually, treatment can have you good as new pretty fast. Heart attacks, on the other hand, are a bit trickier (and more time-limited) in terms of treatment. Heart attacks are also, ultimately, for most people (unless found clearly and VERY early), irreversible.
Finally, critics of the study point out that a lot of the data included people treated with whopping doses of aspirin (500 mg a day, as opposed to a baby aspirin, 81 mg a day) – and using a lower dose may tip the balance even further toward the benefits of heart disease prevention.
Bottom line: Ask your doctor about this new information, but for most patients, the benefits probably still outweigh the risk.
Bonus Points Take Home Message: It’s hard to give something to healthy people that will actually make them healthier - a strong argument against taking medicines indefinitely to prevent disease, unless the long-term data is really, really good.
Conspicuously Left Out Info: The data have never really supported giving an aspirin a day to asymptomatic (never had a heart attack) WOMEN. It’s only men this article is talking about…
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Omega fish oils have some anticoagulant properties, as well as some other nice benefits (eg, skin, possible nerologic benefits, and more). Although very expensive, relative to asprin, fish oil may be good option for the compulsively wellness-oriented among us, would you say?
[...] I take a baby aspirin a day, and Doc Gurley says I should keep on doing so, because I’m better off puking up blood than having a heart attack. [...]