'An Aspirin a Day' Just Another Cliche? Or Should You Take This Advice to Heart? pg 2
By: Tamar Nordenberg

Not for Everyone

Although aspirin is a familiar and readily available drug, people shouldn't take it for its cardiovascular benefits without discussing the risks of long-term use with a doctor, cautions Charles H. Hennekens, M.D., chief of preventive medicine at Brigham and Women's Hospital in Boston. "If someone feels they're a candidate, they should talk to their doctor in making the judgment if the benefits outweigh the risks. "

The same quality that gives aspirin its potential benefit--its ability to inhibit clotting of the blood--may increase the risk of excessive bleeding, including the possibility of bleeding in the brain. Some other possible risks are: - Stomach Irritation. Aspirin can irritate the stomach lining and cause heartburn, pain, nausea, vomiting, and, over time, more serious consequences such as internal bleeding, ulcers, and holes in the stomach or intestines. Chronic alcohol users may be at increased risk of stomach bleeding, as well as liver damage, from aspirin use. - Ringing in the ears. At high doses, aspirin may cause temporary ringing in the ears and hearing loss, which usually disappear when the dose is lowered.

- Allergy. Facial swelling and sometimes an asthma attack may occur in the two out of 1,000 people who are allergic to aspirin, according to the Mayo Clinic in Rochester, Minn.

- In children, Reye Syndrome. While not a problem among candidates for cardiovascular aspirin use, aspirin should not be used for children's flu-like symptoms or chickenpox because of the risk of this rare but serious disease.

- Because of its risks, aspirin is not approved for decreasing the risk of heart attack in healthy individuals. Even Hennekens isn't ready to recommend an aspirin a day for everyone, although he headed up the celebrated 1988 "Physicians' Health Study," which showed aspirin's protective effects in healthy people.

- Why can't this so-called "wonder drug" help everyone? Hennekens' example: A 30-year-old woman's risk of a heart attack is typically "very small, " even over the next 30 years. "It would be unfortunate if such a young woman was taking aspirin, " he explains, "because it would give no benefit and could cause gastrointestinal effects or dangerous bleeding. "

Head Start

In the wide range of patients who could see large benefits, aspirin, regrettably, is not used nearly enough, according to Hennekens. Studies bear this out, including a survey last year of elderly heart attack survivors entering nursing homes, which found that fewer than one in five were taking aspirin.

According to the American Heart Association, 5,000 to 10,000 of the 900,000 lives lost each year to cardiovascular disease could be saved if more people took aspirin upon the first signs of a heart attack. Some typical signs are an uncomfortable pressure or pain in the center of the chest (sometimes along with lightheadedness, fainting, shortness of breath, nausea, or sweating) or a pain going to the shoulders, neck and arms.

Aspirin should be used by "just about everyone" who has survived a heart attack or stroke due to a blocked blood vessel, Hennekens emphasizes, or who within the previous 24 hours has had symptoms of an evolving heart attack.

While appropriate aspirin use is important, experts say it is by no means a cure-all.

"In the time crunch surrounding a heart attack, taking an aspirin provides you a head-start therapy and a better chance for a good outcome, Sopko says. "But it should never be a substitute for a physician's attention. "

And aspirin should not replace a healthy lifestyle or other helpful medical steps, FDA's Bowen says. "Physicians really need to look at aspirin in the context of complete care, as part of a whole treatment plan for people at risk of heart attack or stroke."

Tamar Nordenberg is a staff writer for FDA Consumer.

Three Drinks = No Pain Relievers

Aspirin and all other over-the-counter pain relievers and fever reducers for adults will soon carry a warning to people who drink three or more alcoholic beverages a day: Talk with your doctor before using these drugs. Heavy drinkers may have an increased risk of liver damage and stomach bleeding from these medicines, which contain aspirin, other salicylates, acetaminophen, ibuprofen, naproxen sodium, or ketoprofen.

The alcohol warning is required under an FDA rule (distinct from the aspirin labeling rule) finalized last October. Some newer over-the-counter pain relievers, including Aleve (naproxyn sodium), Orudis KT and Actron (ketoprofen), Advil Liquigels (solubilized ibuprofen), and Tylenol Extended Release (acetaminophen), have already been required to carry a warning for heavy drinkers but were not required to include the specific risks. These products, too, will need to comply with the October rule.