Educational Articles
Aspirin in Heart Attack and Stroke Prevention American Heart Association
AHA Recommendation
The American Heart Association recommends aspirin use
for patients who've had a myocardial infarction (heart
attack), unstable angina, ischemic stroke (caused by
blood clot) or transient ischemic attacks (TIAs or
""little strokes""), if not contraindicated. This
recommendation is based on sound evidence from clinical
trials showing that aspirin helps prevent the
recurrence of such events as heart attack,
hospitalization for recurrent angina, second strokes,
etc. (secondary prevention). Studies show aspirin also
helps prevent these events from occurring in people at
high risk (primary prevention).
You should not start aspirin therapy without first
consulting your physician. The risks and benefits of
aspirin therapy vary for each person.
If you?re taking aspirin and you must undergo even a
simple surgical procedure or dental extraction, you
must tell the surgeon or dentist your aspirin
dosage.
What about aspirin and
alcohol?
The U.S. Food and Drug Administration warns that people
who regularly take aspirin shouldn't drink alcohol.
Patients who have heart disease should stop drinking
alcohol and keep taking aspirin if their doctor
prescribed aspirin as part of the treatment plan for
their heart condition. Don't stop taking aspirin
without talking to your doctor first.
Should I take aspirin during a heart attack
or stroke?
The more important thing to do if any heart attack
warning signs occur is to call 9-1-1 immediately. Don't
do anything before calling 9-1-1. In particular, don't
take an aspirin, then wait for it to relieve your pain.
Don't postpone calling 9-1-1. Aspirin won't treat your
heart attack by itself.
After you call 9-1-1, the 9-1-1 operator may
recommend that you take an aspirin. He or she can make
sure that you don't have an allergy to aspirin or a
condition that makes using it too risky. If the 9-1-1
operator doesn't talk to you about taking an aspirin,
the emergency medical technicians or the physician in
the Emergency Department will give you an aspirin if
it's right for you. Research shows that getting an
aspirin early in the treatment of a heart attack, along
with other treatments EMTs and Emergency Department
physicians provide, can significantly improve your
chances of survival.
Taking aspirin isn't advised during a stroke, because
not all strokes are caused by blood clots. Most strokes
are caused by clots, but some are caused by ruptured
blood vessels. Taking aspirin could potentially make
these bleeding strokes more severe.
Related AHA publication(s):
Aspirin and Your Health
Are You at Risk of Heart Attack or Stroke?
Controlling Your Risk Factors... heart attack and
stroke
Detailed Research
ACC/AHA 2002 Guideline Update for the Management of
Patients With Chronic Stable Angina, Full Text,
#71-0243; Summary Article, #71-0244
ACC/AHA Guideline Update for the Management of Patients
With Unstable Angina and Non-ST-Segment Elevation
Myocardial Infarction, Full Text, #71-0227; Summary
Article, #71-0240
AHA Scientific Statement: AHA Guidelines for Primary
Prevention of Cardiovascular Disease and Stroke: 2002
Update, #71-0226 Circulation. 2002;106:388-91
AHA/ACC Guidelines for Preventing Heart Attack and
Death in Patients With Atherosclerotic Cardiovascular
Disease: 2001 Update, #71-0214 Circulation.
2001;104:1577-1579
AHA Scientific Statement: Primary Prevention of
Ischemic Stroke, #71-0197 Circulation.
2001;103:163-182; Stroke. 2001;32:280-299
AHA Scientific Statement: Supplement to the Guidelines
for the Management of Transient Ischemic Attacks,
#71-0179 Stroke. 1999;30:2502-2511
AHA Scientific Statement: Preventing Ischemic Stroke in
Patients With Prior Stroke and Transient Ischemic
Attack, #71-0178 Stroke. 1999;30:1991-1994
ACC/AHA Consensus Panel Statement: A Guide to
Preventive Cardiology for Women, #71-0160 Circulation.
1999;99:2480-2484
Statement on the Physicians Health Study Report
AHA Scientific Statement: Aspirin as a Therapeutic
Agent in Cardiovascular Disease, #71-0129, Circulation.
1997;96:2751-2753
Alcohol, Wine and Cardiovascular Disease American Heart Association
Are there cardiovascular risks associated with
drinking alcohol?
Drinking too much alcohol can raise the levels of some
fats in the blood (triglycerides) (tri-GLIS'er-idz). It
can also lead to high blood pressure, heart failure and
an increased calorie intake. (Consuming too many
calories can lead to obesity and a higher risk of
developing diabetes.) Excessive drinking and binge
drinking can lead to stroke. Other serious problems
include fetal alcohol syndrome, cardiomyopathy
(kar""de-o-mi-OP'ah-the), cardiac arrhythmia
(ah-RITH'me-ah) and sudden cardiac death.
AHA Recommendation
If you drink alcohol, do so in moderation. This means
an average of one to two drinks per day for men and one
drink per day for women. (A drink is one 12 oz. beer, 4
oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of
100-proof spirits.) Drinking more alcohol increases
such dangers as alcoholism, high blood pressure,
obesity, stroke, breast cancer, suicide and accidents.
Also, it's not possible to predict in which people
alcoholism will become a problem. Given these and other
risks, the American Heart Association cautions people
NOT to start drinking ... if they do not already drink
alcohol. Consult your doctor on the benefits and risks
of consuming alcohol in moderation.
What about red wine and heart
disease?
Over the past several decades, many studies have been
published in science journals about how drinking
alcohol may be associated with reduced mortality due to
heart disease in some populations. Some researchers
have suggested that the benefit may be due to wine,
especially red wine. Others are examining the potential
benefits of components in red wine such as flavonoids
(FLAV'oh-noidz) and other antioxidants
(an""tih-OK'sih-dants) in reducing heart disease risk.
Some of these components may be found in other foods
such as grapes or red grape juice. The linkage reported
in many of these studies may be due to other lifestyle
factors rather than alcohol. Such factors may include
increased physical activity, and a diet high in fruits
and vegetables and lower in saturated fats No direct
comparison trials have been done to determine the
specific effect of wine or other alcohol on the risk of
developing heart disease or stroke.
Are there potential benefits of drinking wine
or other alcoholic beverages?
Research is being done to find out what the apparent
benefits of drinking wine or alcohol in some
populations may be due to, including the role of
antioxidants, an increase in HDL (""good"") cholesterol
or anti-clotting properties. Clinical trials of other
antioxidants such as vitamin E have not shown any
cardio-protective effect. Also, even if they were
protective, antioxidants can be obtained from many
fruits and vegetables, including red grape juice.
The best-known effect of alcohol is a small increase in
HDL cholesterol. However, regular physical activity is
another effective way to raise HDL cholesterol, and
niacin can be prescribed to raise it to a greater
degree. Alcohol or some substances such as resveratrol
(res-VAIR'ah-trol) found in alcoholic beverages may
prevent platelets in the blood from sticking together.
That may reduce clot formation and reduce the risk of
heart attack or stroke. (Aspirin may help reduce blood
clotting in a similar way.) How alcohol or wine affects
cardiovascular risk merits further research, but right
now the American Heart Association does not recommend
drinking wine or any other form of alcohol to gain
these potential benefits. The AHA does recommend that
to reduce your risk you should talk to your doctor
about lowering your cholesterol and blood pressure,
controlling your weight, getting enough exercise and
following a healthy diet. There is no scientific proof
that drinking wine or any other alcoholic beverage can
replace these conventional measures.
What about alcohol and
pregnancy?
Pregnant women shouldn't drink alcohol in any form. It
can harm the baby seriously, including causing birth
defects.
What about alcohol and aspirin?
The U.S. Food and Drug Administration warns that people
who take aspirin regularly should not drink alcohol.
Heart disease patients should stop drinking and keep
taking aspirin if their doctor prescribed it for their
heart condition.
Patients should not stop taking aspirin without first
talking to their doctor.
Related AHA publications:
¥ An Eating Plan for Healthy
Americans
¥ Easy Food Tips for Heart-Healthy
Eating (also in Spanish)
Detailed Research
AHA Scientific Statement: AHA Dietary Guidelines:
Revision 2000, #71-0193 Circulation.
2000;102:2284-2299; Stroke. 2000;31:2751-2766
AHA Science Advisory: Alcohol and Heart Disease,
#71-0097 Circulation. 1996;94:3023-3025
AHA Science Advisory: Wine and Your Heart, #71-0199
Circulation. 2001;103:472-475