Heart Health Treatments

Undermining the Effectiveness of Aspirin Therapy

Many people reach for a painkiller when they have a headache or when their arthritis is acting up, but what if you're already taking aspirin every day? For people taking daily aspirin therapy to reduce their risk of heart attack and stroke, a recent study shows that regular use of other common painkillers might interfere with the benefits of the aspirin.

Aspirin, considered the wonder drug of the century, has been used for more than a hundred years taken to reduce pain. It belongs to a class of drugs known as non-steroidal anti-inflammatory drugs, or NSAIDs. In recent years, aspirin was found to impair platelets, the cells that are involved in clotting blood. This action helps minimize risk for heart attack and stroke by preventing blood vessels from being blocked when the cells clump together, cutting off the blood supply to the heart or brain.

While aspirin is capable of blocking an important enzyme and disabling platelets for good, other NSAIDs can only block the enzyme temporarily.

In the study, which was published in the September 9 issue of the journal Circulation, researchers used data from the Physician's Health Study, a randomized trial of more than 22,000 men that found daily aspirin led to a 44 percent reduction in first heart attack. Researchers examined those participants who used non-aspirin NSAIDs occasionally, defined as less than 60 days a year, and those who used them regularly. They found that men who used non-aspirin NSAIDs regularly did not experience a reduction in heart attacks. (The study did not look at COX-2 inhibitors, a newer class of anti-inflammatory drugs.)

Below, lead author Tobias Kurth, MD, ScD, an instructor of medicine at Harvard Medical School and a researcher in the division of preventive medicine at the Brigham and Women's Hospital in Boston, discusses the study findings and potential options for people on aspirin therapy who need painkillers for other problems.

When is daily aspirin therapy usually recommended?
Daily aspirin therapy is used in both primary and secondary prevention. If you never had a cardiovascular event, but have some risk factors, then daily aspirin therapy to reduce risk of first heart attack is called primary prevention. Secondary prevention is if you are taking daily aspirin therapy after having had a cardiovascular event, such as a heart attack.

It has been known for many years that aspirin is effective in preventing a second event. For primary prevention, if you have a number of risk factors, then daily aspirin is currently recommended to prevent first heart attack.

The American Heart Association recommends 75 mg to 165 mg of aspirin daily for primary prevention, and a daily dose of 75 mg to 325 mg daily for secondary prevention.

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