Reducing the risk: heart disease, stroke and aspirin

Aspirin used in cardiovascular disease is probably the best evaluated and the most highly cost effective prophylactic available in clinical practice today. It has been evaluated in over 150 randomised controlled trials and a small daily dose of around 100 mg has been shown to reduce the risk of myocardial infarction and stroke by about 30 per cent. The saving of lives and prevention of vascular events in patients judged to be at increased risk of a vascular event for any reason is large. In healthy subjects, however, the risk of a vascular event is so low that prophylaxis by any drug is inappropriate. The earlier aspirin is given in the acute phase of a myocardial infarction the greater the saving of lives. Patients judged to be at increased risk of a vascular event, for any reason, should therefore be advised to carry aspirin and to chew and swallow one or two tablets immediately, if they experience sudden severe chest pain. Aspirin is derived from a salicylate, and salicylates are widely distributed in nature, with many functions in plants. Its use in cardiovascular disease derives from an effect on blood platelets, but other possible effects have led to suggestions that it may be of benefit in conditions other than heart disease and stroke. Current research is now focussing on the possible reduction by aspirin in the risk of dementia, certain cancers, retarded foetal growth and cataract.