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Is Aspirin effective in preventing heart diseases?

Q: Can Disprin be taken once in a week instead of taking Ecosprin 75 daily? Does the dose of Ecosprin depend on age, weight or risk? Does it mean that when the patient has higher risk, greater will be the dose if he is overweight and aged? If a person is 50 years old along with being obese and hypertensive, will the doctor give Aspirin 150 or 75? My husband is hypertensive and obese, he weighs 110 kg. The doctor has told him to take Ecosprin 150 in place of 75 since his body requirement is greater. is this correct? If a person has mild antral gastritis with duodenitis in the bulb, is enteric coated aspirin 150 safe? Does Clopedogrel and Aspirin have same side effects as far as gastritis or ulcer is concerned?

A:Healthy habits remain the cornerstone for preventing coronary artery disease (CAD). This includes eating a balanced diet (low in saturated fats and sodium, high in fruits, vegetables, whole grains, and low-fat dairy products), controlling weight (as little as 2.3 kg to 3.6 kg can be effective), getting regular exercise, quitting smoking (and avoiding secondhand smoke) and limiting alcohol to two or fewer drinks per day for men or one for women. As a means of primary prevention, aspirin conclusively reduces the risk of a first myocardial infarction (MI) by about one-third. The American Heart Association (AHA) has recommended aspirin for all apparently health individuals whose 10-year risks of a first CHD event are 10%. In patients with established CAD, aspirin reduces risks of subsequent myocardial infarction by about one-third, stroke by about one-fourth, and vascular death by about one-sixth. Risk factor assessment in adults should begin at the age of 20. This includes regular updating of family history of CAD and assessment of smoking status, diet, alcohol intake, and physical activity. Blood pressure, body mass index, waist circumference, and pulse should be recorded at each visit (at least every 2 years). Fasting serum lipoprotein profile and fasting blood glucose should be measured according to patient’s risk for hyperlipidemia and diabetes, respectively (at least every 5 years; if risk factors are present, every 2 years). Guidelines of The American Heart Association: Not recommend for patients with aspirin intolerance. Low-dose aspirin increases risk for gastrointestinal bleeding and haemorrhagic stroke. Do not use in persons at increased risk for these diseases. Benefits of cardiovascular risk reduction outweigh these risks in most patients at higher coronary risk. Doses of 75–160 mg/d are as effective as higher doses. Therefore, consider 75–160 mg aspirin per day for persons at higher risk (especially those with 10-y risk of CHD of >10%). Safety: A major risk of aspirin therapy is gastric mucosal injury and gastrointestinal haemorrhage. Aspirin increases the risk of major gastrointestinal bleeding, even with low doses. Enteric coating does not appear to reduce such risk. Minor bleeding episodes (epistaxis, bruising, etc.) are also increased. Analysis of prevention trials found a moderately increased relative risk of haemorrhagic stroke in aspirin users. Absolute risk was approximately 1 event per 1,000 users over 3–5 years. Risk did not appear to differ significantly by dosage, but power to detect such differences was limited. Contraindications to aspirin therapy include allergy, bleeding tendency, anticoagulant therapy, recent gastrointestinal bleeding, and clinically active hepatic disease. As low dose of aspirin is a very weak inhibitor of renal prostaglandin synthesis it has no clinically significant effect on renal function or on blood pressure control. Thus, people with aspirin allergy, bleeding tendency, anticoagulant therapy, recent gastrointestinal bleeding, and clinically active hepatic disease are not candidates for aspirin therapy. Other antiplatelet agents may be a reasonable alternative for patients with high risk. Uncontrolled hypertension and concomitant use of other nonsteroidal anti-inflammatory agents or anticoagulants increase risk for serious bleeding. Dose: The platelet release reaction is exquisitely sensitive to inhibition by aspirin. In this regard, it has been shown that a dose as low as 75 mg of enteric-coated aspirin is just as effective as higher doses of either plain or enteric-coated aspirin in inhibiting thromboxane synthesis. The APT meta-analysis explored the results achieved with various doses of aspirin, alone or in combination with other antiplatelet agents, including dipyridamole and sulfinpyrazone. Whereas risk reductions of 21 ± 4% were seen in cardiovascular events in 30 trials in which doses of 500–1,500 mg/day were used, a trend for greater risk reductions of 29 ± 7% was seen in 5,000 patients in whom doses of 75 mg/day were used. Comparable risk reductions of 28 ± 3% were seen in 12 trials in which doses of 160–325 mg/day were used. No evidence was found that combinations of aspirin with other antiplatelet drugs were any more effective than aspirin alone. Because low-dose aspirin (75–162 mg/day) appears to be equally or more effective, and possibly to have lower risk than higher doses, low-dose aspirin should be recommended routinely. The available evidence supports the use of daily doses of aspirin in the range of 75 to 100 mg for the long-term prevention of serious vascular events in high-risk patients. The use of a once-a-day regimen is preferable to the use of an every-other-day regimen because of inter-individual variability in the platelet turnover rate.

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