PRESCRIPTIONS
Aspirin may be right for your health

By Landis Lum

Should I take an aspirin a day for my health?

Anyone who has had a heart attack, stroke, or blocked arteries should be on aspirin or other anti-platelet drug to prevent future heart attacks and strokes.

But what about everyone else?

Aspirin has not been shown to reduce cancers or dementia. But if you're a man older than 40, a woman past menopause, a smoker, or have diabetes, high blood pressure, high cholesterol or early heart disease in your family, then you're at higher risk for a heart attack, and aspirin can cut this risk by a third.

Before popping aspirins, remember aspirin can cause bleeding ulcers and possibly strokes from brain bleeds. So who should take it?

The U.S. Preventive Services Task Force recommends aspirin for anyone with a 6 percent or higher chance of heart disease over 10 years. You or your doctor can figure this out by going to www.intmed.mcw.edu/clincalc/heartrisk.html and entering values for good (HDL) and total cholesterol, blood pressure, age, sex, smoking, and diabetes status.

If you don't smoke or have hypertension or similar risks, you'll hit this 6 percent risk when you're 55, but at a higher age if your HDL is above 59. With diabetes, men should start aspirin at age 40 and women at 45, but at even lower ages if they also have hypertension or bad cholesterols, or if they smoke. For 500 people with a 6 percent risk, taking aspirin for 10 years would cause serious bleeding ulcers in 2 to 4 people, and perhaps 1 to 2 brain bleeds, but would prevent 4 to 12 people from having a heart attack; at 12 percent risk, 8 to 24 would avoid heart attacks.

In those older than 70, aspirin would cause serious bleeding ulcers in 4 to 12 but may prevent even more heart attacks and strokes. What's the right dose? Either a baby aspirin (81 mg) every morning or an adult aspirin (325 mg) every other morning. But ask your doctor first.

Uncontrolled high blood pressure, previous bleeding ulcers and regular use of other anti-inflammatories like Motrin increase the risk for serious bleeding, and those with aspirin allergy, bleeding tendency, recent bleeding ulcers, active liver disease or on anticoagulants shouldn't take it at all.

And don't give it to children or teens for any viral illness, particularly chickenpox or influenza, because it can cause Reye's syndrome, which can kill. Use Tylenol (acetaminophen) or ibuprofen instead. But neither will prevent heart attacks or strokes in adults.

Ten times more women die from heart disease than from breast cancer. Aspirin, a simple but powerful compound derived from willow bark, can save countless lives in both men and women. Should you be on it?

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Questions: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; This column is not intended to provide medical advice.