"Should We All Take Aspirin to Prevent Heart Disease?"Dr Michael Greger
Salicylic acid, the active ingredient in aspirin,
has been used for thousands of years
as an anti-inflammatory pain killer in the form of willow tree bark extract,
which Hippocrates used to treat fever and to alleviate pain during childbirth.
It became trademarked as a drug in 1899, and remains to this day
probably the most commonly used drug in the world.
One of the reasons it remains so popular, despite the fact that
we have better painkillers now, is that it also acts as a blood thinner.
Millions of people now take aspirin on a daily basis to treat or prevent heart disease.
It all started back in 1953, with the publication of this landmark study
in the New England Journal of Medicine,
"Length of Life and Cause of Death in Rheumatoid Arthritis."
The paper started out with the sentence,
"It has often been said that the way to live a long life is to acquire rheumatism."
They found fewer deaths than expected from accidents,
which could be explained by the fact that people with arthritis probably aren't out,
you know, going skiing, but also significantly fewer deaths from heart attacks.
Maybe it was all the aspirin they were taking for their joints
that was thinning their blood and preventing clots forming
in their coronary arteries.
And so, in the 1960s there were calls to study whether aspirin would
help those at risk for blood clots.
And in the 1970s, we got our wish,
studies suggesting regular aspirin intake protects against heart attacks.
Today, the official recommendation is that low-dose aspirin
is recommended for all patients with heart disease,
but in the general population, for those without a known history
of heart disease or stroke, daily aspirin is only recommended
when the heart disease benefits outweigh the risks of bleeding.
The bleeding complications associated with aspirin use may be considered
an underestimated hazard in clinical medical practice.
For those who've already had a heart attack, the risk–benefit analysis is clear.
If you took 10,000 patients, daily low-dose aspirin use would be expected to prevent
approximately 250 major vascular events, such as heart attacks, strokes, or,
the most major event of all, death.
But, that same aspirin would be expected to cause approximately
40 major extracranial bleeding events,
meaning bleeding so bad you have to be hospitalized.
Thus, the net benefit of aspirin for secondary prevention,
meaning like preventing your second heart attack,
would substantially exceed the bleeding hazard.
For every 6 major vascular events prevented,
only about 1 major bleeding event would occur;
so, the value of aspirin for secondary prevention is not disputed.
But, if you instead took 10,000 patients who never had a heart attack or stroke—
yet, and tried to use aspirin to prevent clots in the first place,
so-called primary prevention, daily low-dose aspirin would only be expected
to prevent 7 major vascular events, at the cost of causing a hemorrhagic stroke,
bleeding within the brain, along with 3 other major extracranial bleeding events.
So then, the benefits are only like 2 to 1, which is a little too close for comfort,
which is why the new European guidelines do not recommend aspirin
for the general population,
especially given the additional risk of aspirin causing smaller bleeds
within the brain as well.
If only there were safe, simple, side effect-free solution…
and there is.
Ornish and Esselstyn proved that even advanced crippling heart disease
could not only just be prevented and treated but reversed with a plant-based diet,
centered around grains, beans, vegetables, and fruits,
with nuts and seeds treated as condiments,
and no oils, dairy, meat, poultry, or fish.
Bill Castelli, long-time director of the longest running
epidemiological study in the world— the famous Framingham Heart Study,
was once asked what he would do to reverse
the coronary artery disease epidemic if he were omnipotent.
His answer?
"Have the public eat the diet [of the rural Chinese] as described by Dr. T. Colin Campbell."
In other words, he told PBS, "If Americans ate healthy enough, the whole
heart disease epidemic would disappear,"
though Esselstyn clarifies, we're not just talking about vegetarianism.
"This new paradigm" of heart disease reversal means "exclusively plant-based nutrition."
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