Aspirin — Surprising Alternative to Get the Benefits Without Harm


Story at-a-glance -

  • A number of health conditions are covered under the umbrella term cardiovascular disease, including heart attacks, stroke, coronary artery disease and arrhythmias, the combination of which tops the list of leading causes of death in the U.S.
  • Risks associated with aspirin therapy include upper gastrointestinal bleeding and intracranial bleeding, without associated benefits in people over 50 who do not have a previous history of heart attack or stroke
  • The pathway aspirin uses to reduce clot formation may be the foundation for the development of side effects, while nattokinase, used for centuries in Japan to lengthen life and improve health, is beneficial without these effects
  • Additional lifestyle choices to reduce your risk for cardiovascular disease include reducing inflammation through critical dietary choices and regular movement and exercise throughout the day

By Dr. Mercola

There are a number of conditions that come under the umbrella term of cardiovascular disease. The term includes diseases of the blood vessels, which increase the potential for developing coronary artery disease, arrhythmias and stroke.1 Each year, heart disease is on the list of serious health conditions and one of the leading causes of death in the U.S.

According to the American Heart Association, nearly 84 million people in the U.S. suffer from some form of cardiovascular disease, which now kills 1 in 3 people.2 The direct and indirect costs amount to nearly $315 billion and increases each year. Nearly one-third of deaths from cardiovascular disease occur before age 75.

Stroke is a leading cause of long-term disability. Women have a higher lifetime risk than men and, on average, someone in the U.S. suffers a stroke every 40 seconds. Risk factors for heart disease include high blood pressure, smoking, diabetes, obesity and physical inactivity.3

Faced with overwhelming numbers of patients with risks for cardiovascular disease and the numbers who die each year, the U.S. Preventive Services Task Force developed recommendations hoping to reduce the risk of heart attack and stroke using aspirin.4 While followed by many, recent research suggests the potential risks may outweigh any perceived benefit.

Potential Benefit to Aspirin May Be Outweighed by Risk

Aspirin (acetylsalicylic acid) is one of the oldest modern medications, first marketed by the Bayer company in 1897.5 As described in this short video, many physicians recommend a low-dose aspirin-a-day regimen to prevent heart attack and stroke in people with risk factors, or who have had a previous heart attack or stroke.

Recently, a trio of studies was published in the New England Journal of Medicine demonstrating daily low-dose aspirin provides no significant health benefits for healthy older adults.6 Instead, the data demonstrated this strategy may increase the potential for serious harm. The first study was a randomized, double-blind, placebo-controlled trial from Monash University in Australia.7

Nearly 20,000 people participated from Australia and the U.S. over age 70 and considered healthy at the start of the study. Half the participants received 100 mg of aspirin a day and the other half took a placebo. The trial was terminated at a median of 4.7 years follow-up as the researchers determined there would be no benefit of continued aspirin use with regard to the primary endpoint of the study.

Data demonstrated8 aspirin use in this population did not prolong disability-free survival over a period of five years, but in fact led to a higher rate of major hemorrhage (bleeding) than the placebo. The second study9 confirmed these results, finding the risk of major hemorrhage was primarily in the upper intestine gastrointestinal tract and intracranial bleeding.

The third study10 found higher all-cause mortality in apparently healthy older adults who used aspirin. Interestingly, this data attributed death primarily to cancer-related events. These results support previous data11 demonstrating the benefit of aspirin therapy in the primary prevention of cardiovascular disease may not outweigh the risk.

One of the primary potential adverse effects from aspirin use is bleeding, and the most common site is the stomach or intestines. Individuals with a history of stomach ulcers, long term use of anti-inflammatory medications or long-term users of anticlotting drugs may have a higher risk.

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Aspirin Plus Gut Bacteria Increases Your Risk of Gastrointestinal Bleeding

Another recent study published in the medical Journal of Australia found individuals with a Helicobacter pylori (H. pylori) infection who take low-dose aspirin have an even higher risk of upper gastrointestinal bleeding than those taking aspirin without the infection.12

H. pylori is a spiral-shaped bacterium that may adhere to the epithelial lining of the stomach.13 It is responsible for more than 90 percent of duodenal ulcers and 80 percent of gastric ulcers. Nearly two-thirds of the world's population are infected but not everyone infected is symptomatic.

Several methods are used to diagnose H. pylori infection, including a blood test measuring specific antibodies or a breath test following the consumption of a specific carbon labeled drink. As H. pylori metabolizes urea rapidly, the labeled carbon is absorbed and can then be measured in expiration.14

In a meta-analysis of four high-quality studies, researchers found upper gastrointestinal hemorrhage was more frequent in those using aspirin and who were infected with H. pylori than in those who were not. While the researchers found the risk almost doubled, the exact nature of the interaction was unclear. The authors hypothesized the relationship may be antagonistic, suggesting:15

“From a pathophysiological perspective, the interaction could conceivably be antagonistic rather than additive or synergistic; for instance, H. pylori infection stimulates the production of gastric mucosal prostaglandins, which may counter the depletion resulting from inhibition of mucosal cyclooxygenase-1 by aspirin.”

However, as it is costly and time-consuming to test for and treat H. pylori infections, the researchers believed it is not practical to treat all patients on low-dose aspirin for H. pylori. Instead, they suggest patients who are at higher risk of ulcer complications be closely monitored or other forms of treatment used.16

How Aspirin Works

Aspirin is the first nonsteroidal anti-inflammatory drug (NSAID) discovered and has been used to reduce pain and swelling in conditions such as muscle aches, toothaches and headaches.17 It works by blocking natural substances known as cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). These enzymes produce prostaglandins, a hormone-like molecule that triggers inflammation.18

Aspirin works in a way unique to other NSAIDs as it splits into two parts. One part attaches to the enzyme and the other blocks the reaction that produces prostaglandins.19 One particular prostaglandin, thromboxane A2, makes platelets sticky, increasing the potential to form clots.

As aspirin inhibits COX-1, and therefore the production of thromboxane A2, it interrupts the chain of events and reduces the formation of clots.20 Aspirin has been used as an antiplatelet medication to prevent blood clots from forming in the prevention of a clot-based heart attack or stroke. This is the desired result when aspirin is used as a preventative in cardiovascular disease.

However, it is also the basis for the significant side effect of intracranial and gastrointestinal bleeding, as platelets are necessary to stop bleeding from minor injury. Risk factors physicians have used to determine if aspirin prevention may be helpful include hypertension, diabetes, smoking and high cholesterol levels.21

The U.S. Preventive Services Task Force recommends adults between the ages of 50 and 59 years who do not have a high risk of bleeding and are likely to live at least another 10 years take low-dose aspirin to prevent cardiovascular disease.22

Prostaglandins help protect the lining of your stomach through the production of acid neutralizing biocarbonate and protective mucus. Inhibiting COX-1 reduces these prostaglandins and increases the risk of bleeding and ulcers.23 Inhibition of COX-1 may increase blood pressure or reduced kidney function, especially in the elderly or patients who have previous kidney disease.

Nattokinase Reduces Clot Formation Without Side Effects

Natto is a fermented soybean product that has been eaten as a traditional food in Japan for thousands of years.24 Nattokinase is produced by the bacteria Bacillus subtilis during the fermentation of soybeans to produce natto.

Benefits found have included dramatic effects on breaking down blood clots, reducing production of blood clots and benefits to persistent sinus conditions. Without conventional drugs, nattokinase has been a powerful way to reduce chronic rhinosinusitis under study conditions.25

Clinical studies have determined nattokinase dissolves excess fibrin in blood vessels, improving circulation and reducing the risk of serious clotting. It also decreases blood viscosity and improves blood flow, consequently lowering blood pressure. Nattokinase is a strong thrombolytic, comparable to aspirin without the same serious side effects.

According to one study, consuming nattokinase was associated with a decrease in systolic and diastolic blood pressure.26 Studies in humans and animals have demonstrated it supports the circulatory system, thinning the blood and dissolving clots. It has also been effective in reducing deep vein thrombosis, or blood clots, in individuals who are on long-haul flights or vehicle travel.27

While use of aspirin and statin medication come with a long list of serious side effects, the use of nattokinase, used for centuries with few reported side effects, is only recently undergoing phase II clinical trial studies in the U.S. for atherothrombotic prevention. Studies have demonstrated single dose administration enhances clot breakdown and anticoagulation.28

Reduce Your Cardiovascular Risk Making Simple Lifestyle Changes

There are a number of factors with the potential to impact your cardiovascular health. Diet, exercise and sleep play a significant role. A study looking at longevity confirmed low levels of inflammation in your body are the most potent predictors for living a long life. Inflammatory levels also correspond to the ability to maintain cognitive function and live independently.

Avoiding processed foods, often high in inflammatory agents such as refined sugars and processed fats, is your first step. Your nutrition is responsible for nearly 80 percent of the health benefits you reap from a healthy lifestyle and keeps your inflammation in check.

If you are unsure of how to make the necessary changes to reduce inflammation, and therefore your risk of several diseases, I suggest following my free Optimized Nutrition Plan. The plan starts at a beginner phase and will systematically guide you step-by-step to an advanced level.

Regular movement and exercise helps to normalize your insulin levels and avoid insulin resistance. While you may think of physical activity as a regimented fitness routine, what you do outside the gym plays an equally important role in your overall health and wellness.

The average adult spends nearly 10 hours a day sitting. This level of inactivity simply cannot be counteracted with a 60-minute workout each day. Chronic sitting is an independent risk factor for insulin resistance and early death, even when you eat right and exercise regularly.29

For more information on integrating exercise and diet to combat inflammation, including a list of anti-inflammatory foods you may consider including in your dietary plan, see my previous article, “Exercise and Diet Combat Inflammation, Allowing You to Live Longer.”