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Aspirin redux. (Guest Editorial).
One of the relatively few rewards of attending cocktail parties is the opportunity they provide to exercise one's mental processes on unsuspecting individuals. So it came with great pique when an unwitting foil at a recent gathering introduced himself and asked whether, as a cardiologist, I had taken my aspirin today. "Of course not," I responded. At that point, what might have been an otherwise benign social encounter immediately turned bad.
"Why don't you practice what you preach? Haven't you read the Wall Street Journal or, better yet, the New England Journal of Medicine?" My social companion immediately branded me a heretic and an antiquity totally out of the mainstream of medicine. Was I not aware that the U.S. Preventive Services Task Force had recommended aspirin for preventing heart attacks in otherwise healthy individuals?
Aware? Yes. Convinced of the recommendation's validity? Not entirely.
The use of aspirin for primary prevention of cardiac events in asymptomatic individuals can be traced back to a landmark finding from the Physicians' Health Study (N. Engl. J. Med. 321[3]:129-35, 1989). Treatment with aspirin decreased the occurrence of heart attacks by approximately 84 events in 22,071 asymptomatic physicians in the United States during a 5-year period. Mortality was not decreased, however, and sudden deaths were doubled.
These findings raise some interesting choices in regard to life and death. As Woody Allen once said, "I don't mind sudden death, I just don't want to be there when it happens." Death is to be avoided, and although sudden death occasionally can be a blessing, the alternative of having a myocardial infarction is not exactly appealing either. Taking an aspirin a day may make me socially acceptable, but clearly it has some undesirable side effects.
Beyond the hyperbole of the Physicians' Health Study, a study of over 5,000 British doctors failed to find any benefit to daily aspirin by the otherwise healthy (BMJ 296[6618]:313-16, 1988).
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Source: HighBeam Research, Aspirin redux. (Guest Editorial).