It's cheap, it's old, it's in your face, it's frustrating, and it's bitter. No, you cynics, that's not a description of the writer. Rather, the foregoing is a partial description of aspirin, an old, inexpensive, ubiquitous drug that we're still not sure how to use properly, especially in preventing heart attacks.
You see, heart attacks occur mostly from blood clots that block coronary arteries, and aspirin lowers the blood's clotting ability by making platelets - blood cells intimately connected to forming clots - less "sticky" and thus less able to clump. So, anyone who's already had a heart attack significantly lowers their risk of suffering another when they take aspirin regularly, and people who have 2 or more risk factors for heart attack, especially diabetics, lower their risk of suffering a first heart attack by taking aspirin regularly.
And when it comes to the best dose of aspirin to use to obtain this benefit, it turns out that this is another example of the "less is more" phenomenon, because whereas most early studies used doses up to 1000 mg a day to get aspirin's anticlotting effect, more recent studies have used much smaller doses, such as the 80 mg in a "baby" aspirin, and have achieved similar results.
But here's the million dollar question, and, yes, you can call a friend to help but I'm sure your friend won't know the answer either: should people with no extra risks take aspirin, too?
As usual, there are 2 answers: theirs and mine. First, a study in the Archives of Internal Medicine reviewed several studies involving more than 50,000 individuals and found that aspirin did lower the risk of a first heart attack overall in this large population (although it didn't lower the risk of death from vascular disease or of stroke).
Before I hear too many shouts of glee, however, let me say that what bothers me here is that some people read this news and immediately conclude that taking a pill will solve their problems. They then ignore everything else they should be doing for the health of their hearts, and as someone who believes fervently in lifestyle adjustment over chemical intervention, I would caution that no pill can do as much good for the average person's heart as would attention to a healthier lifestyle. And if you're already living a healthy lifestyle, I don't see why you would need any chemical help.
I also want to remind you that aspirin is linked to a much higher risk of bleeding ulcers, and sudden rupture of an ulcer, both of which can result in disability and (more rarely) death. And taking coated aspirin does not help, because although coated aspirin lowers the risk of upset stomach, there's no evidence it prevents these more serious complications.
So where does that leave you? Well, in the days when doctors still decided things for patients, most of you would have been told to take an aspirin (or 2, or not), and that would have been that. Now, we're in an era of patient empowerment, and the doctor only advises - you have to make up your own minds about what to do. Isn't it great to be so empowered?