By Beth Israel Deaconess Medical Center Correspondent

Back in the 1980s, research emerged touting aspirin’s starring role in heart attack prevention. Studies showed that a small daily dose of aspirin could reduce the risk of heart attacks — not only in patients who had already had a heart attack (secondary prevention), but also in healthy patients who had never had an attack (primary prevention).

(Photo: iStockphoto)

(Photo: BIDMC/Shutterstock)

Over-the-counter drug manufacturers were quick to play up the connection, producing “low dose” versions of their products and marketing campaigns with a “heart health” slant.

But in 2014, the U.S. Food and Drug Administration (FDA) sent a message to consumers stating that it no longer supported “the general use of aspirin for the primary prevention of a heart attack or stroke.” The American Heart Association (AHA) — and other influential groups — disagreed. Controversy ensued.

So what’s the truth about the relationship between aspirin and heart health?

“It’s complicated,” says Dr. Robert W. Yeh, Director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center and an interventional cardiologist in the CardioVascular Institute. “It’s more effective for some populations and conditions, and less so for others.”

First Things First

To understand the aspirin controversy, it helps to know a bit about heart attacks. Most heart attacks are caused when built-up plaque (a fatty deposit) in a coronary artery ruptures. The ruptured plaque attracts platelets — colorless cells that circulate in the blood and reduce bleeding by promoting clotting. If too many platelets arrive on the scene, they can form a clot that’s big enough to block the artery.

This blockage prevents oxygen-rich blood from getting to the heart. The oxygen-deprived muscle cells of the heart start to die, which causes the heart attack.

Aspirin is an anticoagulant or “blood thinner.” More specifically, it’s an anti-platelet agent, which means that it inhibits platelets from getting to work. Aspirin is so effective, people who are having a heart attack are advised to chew and swallow an uncoated aspirin. Within five minutes, platelet activation drops significantly, slowing the growth of the blockage. This can reduce damage to the heart muscle.

What’s All the Fuss About?

Sounds good, right? Aspirin’s anti-platelet superpower is, however, a double-edged sword. It comes in handy during a heart attack.

“But, when taken over the long term, it can have some negative side effects,” says Dr. Yeh (right). “Things like bleeding, bruises, peptic ulcers and other gastrointestinal bleeding.”

These negative side effects are at the heart of the aspirin controversy. The FDA no longer believes that aspirin’s benefits outweigh the potential risk of increased bleeding.

“For primary prevention, the data is still unclear,” Dr. Yeh says. “Some large observational studies suggest that women don’t benefit as much as men.”

Above content provided by CaridoVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted February 2016