How We Learned That Aspirin Can Prevent Heart Attacks:
Although aspirin is now widely used to help prevent heart attacks, it actually took decades before it was recognized as beneficial. Aspirin was introduced to relieve pain and lower fever around the turn of the 20th century.
In 1950, Dr. Lawrence Craven, a physician practicing in Glendale, California, noticed that tonsillectomy patients given Aspergum for relieving post-operative pain were more likely to develop bleeding complications than those who didn’t use that method of pain relief. At the time, this was a new product, a chewing gum containing aspirin (ASA, acetylsalicylic acid).
He concluded that it was unwise to use Aspergum after tonsillectomy. He didn’t stop there, though. He hypothesized that heart attacks were caused by a clot lodging in arteries leading to the heart and suggested that regular aspirin use might help prevent heart attacks.
Middle-Aged Men on Aspirin Didn’t Have Heart Attacks:
Dr. Craven began recommending aspirin to his male patients to prevent heart attacks. He kept careful records, and reported that over several years, none of the nearly 1,500 men taking aspirin had died of a heart attack although many had risk factors such as overweight or inactivity. His recommendation that high-risk men between 45 and 65 years old take aspirin to prevent heart attacks was published in the Mississippi Valley Medical Journal in 1953 (Texas Heart Institute Journal, 2007).
Dr. Craven recognized that his observation needed to be followed by further scientific study. This was before the randomized, placebo-controlled clinical trial had become the gold standard for drug research. It is a shame, however, that his publication was largely ignored for so many decades.
Aspirin Acknowledged to Prevent Heart Attacks:
It wasn’t until 1989 that cardiologists embraced Craven’s recommendation, although many probably had never heard of him. The publication of the Physicians’ Health Study in the New England Journal of Medicine (July 20, 1989) was the RCT that was needed to convince academic researchers and practicing cardiologists alike that a dose of 325 mg (a regular aspirin tablet) every other day could reduce the risk of a heart attack by 44%. (That is a relative risk. The chance of having a heart attack, based on data from more than 22,000 male physicians participating for about five years, went from 439 per 100,000 among those taking placebo to 255 per 100,000 among those on aspirin).
Don’t Do This at Home:
The FDA has repeatedly warned that taking aspirin to prevent heart attacks is not a do-it-yourself project. It frequently points out the hazards of aspirin, which include a risk of gastrointestinal irritation and even bleeding ulcer. Those risks hold even for people taking the low dose of 81 mg suggested for cardiovascular protection.
A British meta-analysis of multiple studies including around 100,000 people showed that, while aspirin reduced the risk of heart attack by 20%, it increased the risk of perforated ulcer by 30% (Archives of Internal Medicine, Feb. 13, 2012).
Healthy people might not get enough benefit (in the form of protection from a very unlikely heart attack) to justify the risk of an ulcer. But many people don’t realize that aspirin is unique in its protective effects.
Other Pain Relievers Are Not Just Like Aspirin:
Other pain relievers, such as ibuprofen and naproxen, actually increase the risk of a heart attack or stroke along with the possibility of intestinal damage. We have written about the risks of such NSAIDs (nonsteroidal anti-inflammatory drugs) here.
Acetaminophen:
Some people mistakenly believe that the popular pain reliever acetaminophen is similar to aspiring in its heart protection effects. This reader had made this assumption:
Q. I cannot tolerate daily aspirin to prevent a heart attack. I take Tylenol instead. Is that as effective as aspirin for helping the heart?
A. There is no evidence that acetaminophen (Tylenol) helps the heart. On the contrary, scientists have asked whether this drug might increase the likelihood of heart attacks or strokes as other non-aspirin pain relievers such as ibuprofen and naproxen do.
A ten-year study from the UK found no link between acetaminophen and cardiovascular complications (Hypertension, May, 2015). That is reassuring, but it doesn’t translate to heart benefits from acetaminophen. There is no evidence that acetaminophen can prevent heart attacks.
You may be interested in our free Guide to Key Aspirin Information.
