Everyone knows an aspirin a day keeps heart attacks away. But is a daily dose of aspirin “right” for you ? It’s time to weigh up the evidence
Click to listen to the audio…
The cardiovascular power of a pain killer (aspirin) unplugged
A couple of drugs have made it into THE DRUG HALL OF FAME – they’re household names and widely prescribed. Maybe……….. too widely prescribed ?
Aspirin is one of those star performers.
It’s an over achiever.
It’s initial claim to fame stemmed from it’s ability to relieve pain IN THE MOMENT.
Aspirin the pain killer
Headaches, tooth aches, bee stings and hangovers all respond to the little white pill. And around the globe, the pill is almost universally available without a prescription – so it’s part of EVERYMAN’S pharmacological toolkit.
But it’s superstar status extends way beyond PAIN RELIEF.
Aspirin the heart saver
It’s one of THE MEDS, used to combat cardiovascular disease. It’s routinely prescribed to people at high risk of suffering a HEART ATTACK.
And there is plenty of science backing up it’s efficacy.
Above is the data from a recent meta analysis of 15 studies confirming aspirin use is associated with a lower risk of a heart attack compared to controls.
Aspirin for EVERYONE !
It’s often prescribed by health care providers and many people opt to self-prescribe it, believing swallowing a baby aspirin every day is an elixir for health.
So is it ?
Should you be pro-active and include an aspirin a day, in your health regimen ?
Maybe, maybe not
All drugs give and they take, whether a drug is right for YOU, depends on your situation. To critically consider YOUR SITUATION, it is helpful to understand how low dose aspirin works.
To explore what is happening we need to eaves drop on cell conversations….
Cells chit chat using the eicosanoid language
Cells are continuously chatting to the cells in the neighbourhood via the eicosanoid language.
Listening in on the cell chit chat is quite difficult, because levels of these chemicals is extremely low and they only exist for a very brief period of time. Scientists are still trying to learn the language, but they have identified a number of these chemicals.
Some of the more well known chemicals in the language are
- Prostaglandins such as PGE2, PGF
- Leukotrienes such as LX1
- Thromboxanes – TX1
The language has lots of words each carrying its own particular message. Translating all of the words is very complex so to keep things simple, scientists just translate the gist of the conversation.
The conversation between the cells is either :
- happy i.e. “everything is okay” – this message is communicated by “good” eicosanoids or
- very negative i.e. “I’m in trouble, help” – this message is communicated by “bad” eicosanoids
Now when it comes to cardiovascular health, the conversations of platelets MATTER.
Platelets, also sometimes called thrombocytes, are actually not really cells at all, they are little bits that have broken off a giant cell called a megakarocyte.
Platelets function as a biological polyfiller that is used to plug holes and hold things together. But in order for them to be useful, they need to be sticky when there is a hole and not sticky when there isn’t.
They know what to do because they listen to the eicosanoids.
When they hear cells screaming in distress, they immediately respond, and join in the hysteria. Calling out loudly to draw the attention of other platelets via the production of thromboxanes.
Scientists classify thromboxanes as “bad” eicosanoids because they are being produced when there is TROUBLE. But in the big scheme of things, the thromboxanes are most helpful, they help the platelets turn sticky, so they start to join up with one another in a process called platelet aggregation.
Aggregated platelets plug holes.
And avert crisis situations.
Endothelial cells are often in trouble
Especially in the metabolically challenged…..
The cells lining the blood vessels tend to be sending out the message “Help I am in trouble” all the time for a variety of reasons
- high sugar levels cut into the endothelial cells lining the blood vessels
- hormone imbalances can precipitate shortages of oxygen
- high blood pressure, creates pressure in the pipes which causes little tears in the blood vessels which need to be plugged
But endothelial cells are not the only ones activating the platelets…..
Fake messages of distress
Rogue bacteria sometimes also send out fake messages of distress. Tricking the platelets to come to their “rescue”, they use the platelets to create floating bacteria castles. Learn more here.
Big castles block blood vessels with disastrous consequences.
When platelet plugs become blocks
Whenever blood vessels spring a leak, the platelets rush in to plug up “holes”. Checks and balances should keep the “plug” size in proportion to the “hole” size. Unfortunately, if you have BAD BODY CHEMISTRY, platelet clumping can be out of proportion to the size of “the hole”.
So the “little” plug morphs into a blood stopping block.
Depriving cells in the neighbourhood of life sustaining oxygen – death and destruction follows.
How big the block is, and where the block is, determines what goes wrong :
- in an ordinary blood vessel – the block is a thrombosis,
- in a cardiac artery – the block is a myocardial infarction or heart attack.,
- in a brain blood vessel – the block causes a stroke
Big blocks in the wrong place can KILL.
So how does aspirin work ?
Officially aspirin breaks an enzyme known as the cyclooxygenase enzyme, this puts a stop to cell talk because it terminates eicosanoid production.
Now this action of aspirin is a bit unusual.
Many drugs work by interfering with enzyme activity, but only a hand full of drugs actually permanently break the enzyme they interact with. Aspirin really breaks the enzyme and its’s this ability that gives it, it’s cardiovascular super power.
All cells are MUTED
Since cyclooxygenase is one of the main enzymes producing the eicosanoids. Once aspirin meets up with the enzyme it no longer works i.e. NO enzyme = no eicosanoids and very little cell talk.
All eicosanoids are impacted.
Exactly what is made by the cyclooxygenase enzyme depends on the cell type and membrane composition.
NOTE : Interestingly enough, diet influences the membrane composition. Diets rich in linoleic acid (this is the fatty acid that is dominant in vegetable/seed oils) creates more “bad” eicosanoids, so it inadvertently contributes to inflammation. Visit then Vegetable oil library page to learn more. Diets rich in omega-3 create more “good” eicosanoids.
Calls for help can’t be made in the short term
By breaking the cyclooxygenase enzyme, aspirin ensures no messages, good or bad, get through. Traumatic events experienced by the cells lining the blood vessels largely go un-noticed.
It’s a temporary effect.
The gag on ordinary cell talk, only lasts a very short time, because aspirin doesn’t stick around in the body for very long. As soon as the aspirin has left the body, the body cells immediately make new enzyme and resume conversations. This means endothelial cells can scream blue murder when they get hurt.
Calls for help fall of deaf ears
But platelets are not so lucky – they are silenced permanently because platelets are not really cells, they don’t have any way of replacing the destroyed cycloxygenase enzyme like regular cells.
An encounter with aspirin means the platelet’s enzyme is broken.
The platelets float around for the rest of their rather short lives, unable to glue anything.
Leaks become rivers
No working platelets means even if there are screams for help, the platelets can’t help because they cannot stick together to form a plug / clot. On the plus side : no plug / clot means no blockages of blood vessels so you are less likely to have a heart attack or stroke.
But other organs can and DO experience collateral damage.
The gastrointestinal system is particularly vulnerable. So is the brain. Approx 20 % of strokes are the result of BLEEDS not BLOCKS.
It’s a delicate balance. …..
Platelets are not THE ENEMY
The problem all starts with bad body chemistry…..
They misinterpret the signals, getting ALL FIRED UP – it’s there overzealous response that’s the problem.
NOTE : Shortages of nitric oxide play a big role in platelet misbehaviour. To learn more about nitric oxide, visit the nitric oxide library page.
Disarming platelets is not always the way to go
Current guidelines do not recommend EVERYONE takes a baby aspirin.
And if you choose to take it, do what you can to mitigate the risks and maximize the benefits. One way to do this, is to adjust the timing of your aspirin dose. I’ll share more about this in an upcoming video, in the mean time, visit the aspirin library page for more information.
The Efficacy And Safety Of Aspirin As The Primary Prevention Of Cardiovascular Disease: An Updated Meta-Analysis. Therapeutics and Clinical Risk Management (2019) 15: 1129–1140. Wenchao Xie, Ying Luo, Xiangwen Liang, Zhihai Lin, Zhengdong Wang, Ming Liu
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