The cardiovascular power of a pain killer (aspirin) unplugged

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


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The cardiovascular power of a pain killer (aspirin) unplugged

Cartoon of aspirin with all its medals and accolades

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

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.

Meta analysis showing how aspirin protects from heart attacks

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.

A group of cells talking some are having happy conversations others are not

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

Good and bad eicosanoidsThe 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.

Platelet conversations

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.

Platelets reacting to the cries of an cell being bitten by a sugar molecule

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.

Platelets successfully plugging a leak in a blood vessel

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

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.

Blood vessel blocked up because of overzealous platelets

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.

Blood vessel springing a leak because platelets cannot stick

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.

Snapshot of the guidelines regarding aspirin use

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.

Aspirin Use to Prevent Cardiovascular DiseaseUS Preventive Services Task Force Recommendation Statement.  JAMA (2022)  327(16): 1577 – 1584.  US Preventive Services Task Force

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

Further reading

blood vessel torture with a blood pressure cuff

Blood vessel torture can save hearts and lives

Remote ischemic preconditioning, uses a blood pressure cuff, to deliberately cut off the blood supply – it’s cruel, but in the end, practice makes perfect

sugar stripping the glycoccalyx

Blood vessels clog up when they become sticky

A special non-stick layer, known as the glycocalyx, prevents things from sticking to the sides of blood vessels. When it’s not there, atherosclerosis happens.

insulin supervising plaque formation in artery

Insulin steers the assembly of killer blood clots

The details are still a little fuzzy but insulin is definitely part of the story of atherosclerotic plaque formation in the carotid artery.


Want to discover more ways to create BETTER BODY CHEMISTRY ?