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.