RX FOR READERS: An aspirin a day...

It may be possible to reduce the risk of heart disease by taking aspirin.

Asprin heart 521 (photo credit: MCT)
Asprin heart 521
(photo credit: MCT)
As I am a middle-aged man, while talking to friends who are contemporaries I hear more and more of them say they use aspirin to reduce their risk of heart disease. The men usually start taking it at 45 and the women around 55. But I know that aspirin can cause bleeding in the digestive system because it thins the blood – which is also the way it reduces the risk of blood clots that cause heart attacks. Should people with or without heart disease take aspirin prophylactically, and at what dose?
– N.S., Ramat Hasharon
Dr. Ilan Kitzis, a senior Tel Aviv Sourasky Medical Center cardiologist and head of clinical cardiology in the community in the Israel Cardiology Association, replies:
Aspirin has a long history. Around 400 BCE, Hippocrates – who is considered the father of medicine – prepared a medication from willow tree leaves to ease fever and pain. The material in those leaves is, in fact, the active ingredient in aspirin. It is known today as salicylic acid, and in 1897 was the first drug synthesized in the lab. Today, about 10,000 tons of aspirin are manufactured annually around the world.
It is one of the leading drugs used in the Western world.
Salicylic acid is a member of the NSAID (non-steroidal anti-inflammatory drug) family, used for relieving pain, reducing fever, easing the symptoms of inflamed joints and minimizing the risk of clot formation.
Due to this last characteristic, many people – men and women of the ages you gave – who are in high-risk groups for heart disease, such as those with a family history, obesity, smoking, high cholesterol and hypertension, take aspirin daily. Today, doctors recommend taking aspirin in real time if one feels heart attack symptoms. In this case, after calling for medical help, one should chew the aspirin quickly and swallow the medicine; this is the fastest way for the active ingredient to reach the bloodstream.
Not only men benefit from salicylic acid, which has been proven to reduce the risk of heart attacks. In women, aspirin has been shown to cut the risk of stroke.
The daily amount of aspirin needed to reduce the formation of blood clots is a low dose, unlike the higher dosage taken for actually treating conditions such as pain and fever. In 2009, the US Preventive Service Task Force met and set down recommended doses of aspirin to lower the risk of heart and vascular diseases. The task force decided on under 100 milligrams daily of “baby aspirin.” Consult your physician to make sure you have only minimal side effects or none at all.
I am a 52-year-old woman. As there is osteoporosis in the family, my doctor recommended taking calcium supplements that include vitamin D, even though tests have not found evidence of bone thinning.

But living in Israel, I know that the hard water is a factor that increases the risk of kidney stones, and I have heard that calcium supplements can actually cause kidney stones. Is this true and something to ask the doctor who prescribed the pills in the first place?
– R.N., Karkur

Prof. A. Joseph Foldes, director of the Osteoporosis Center at Hadassah-University Medical Center on Jerusalem’s Mount Scopus campus, comments:
For women above the age of 50, regardless of bone density status, the general recommendation for vitamin D supplements is a daily dose of 800 to 1,200 International Units. If vitamin D is checked in a blood test and shows a sub-optimal level (<30 ng/ml.), the dose may be increased according to the physician’s recommendation.
The recommended total daily calcium intake (food and supplements combined) is 1,000 mg. to 1,200 mg., regardless of bone density status. Some experts believe that getting calcium from sources in one’s food may be safer than taking it in pill form, but most women will fail to reach the calcium intake goal through their diet only. That means most women do not need to consume more than 500 mg. to 600 mg. per day of calcium in supplement form, and with these doses, there appears to be no increase in cardiovascular morbidity or risk for kidney stones. Thus, moderation is the slogan.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.