Baby Aspirin or Fish Oils? Ask the Pharmacist

Q) Should I take a baby Aspirin or fish oils (Omega 3’s ) daily?

A) People may wonder why it seems I write about these every year or two. There are two reasons for this. One is that they are both very common queries we entertain at our pharmacy counter. Secondly, despite the fact that both of these have been around for seemingly forever (Aspirin is now more than a century old), new research has continued to change the answers we provide despite the passage of all this time.

I deliberately used the plural because there is no single answer that applies to everyone. It very much depends upon other factors that change from individual to individual and, in particular, your past and present health status.

When it comes to Aspirin (or ASA or acetylsalicylic acid), we find that the growing body of information that we have accumulated continues to narrow the spectrum of just who will benefit by taking a low dose (defined as 81 or 80mg) every day.

We have known for many years that for the vast majority who have suffered a previous heart attack or stroke, a daily Aspirin (or an alternative blood thinner for some) helps save lives and preserve your quality of life by helping to prevent future blood clots which can cause a second cardiovascular accident from occurring. At pennies a day, it’s one of the most effective ways of saving lives.

We have also known for some time, that those with no apparent risk of having a heart attack or stroke do not benefit from taking an Aspirin a day, but that leaves a lot of people in what I would call the grey middle area. These are people who have not had a previous event but are at risk for it due to a variety of factors such as being a diabetic, having high blood pressure or high cholesterol.

In an attempt to answer this question, a study conducted in Boston recently wrapped up. In this trial, 12,546 people (all of whom were deemed to be at moderate risk of a future heart event) were followed for 5 years and were given either an Aspirin (100mg a day) or a dummy pill, known as a placebo, daily. At the end of this study, 4 % of each group had suffered a heart problem but 1% of Aspirin takers had experienced an internal bleed which was twice as many as those who were taking the placebos.

The Aspirin users also had a greater chance of suffering from heartburn, indigestion and nosebleeds. What was of further interest was the fact that the so called dummy group had such a low incidence of heart events. This 4% number is significantly lower than we would expect to find in the general population who were at risk for heart events.

Researchers believe that this may be due to the fact that these people did a better job of regularly taking their other prescription drugs (such as blood pressure and cholesterol lowering pills) than most people do since they knew they were being monitored in a study and did not want to get rapped on the wrists by the doctor for non-compliance. This might well be a testament to just how good these drugs are at lowering the risk for heart attacks leaving Aspirin with little chance of helping much more.

In a similar study conducted by researchers from Oxford, 15,480 type 1 and 2 diabetics were monitored for 7 and a half years and it was found that those who took Aspirin had a lower risk of CV events but this was equally offset by more cases of serious bleeds. This latter study also assigned a separate group to take 1 gram a day of fish oils, a great source of Omega 3 fatty acids. This group did not seem to have any less of a risk from heart events than those who took a placebo pill.

Other studies are looking at whether different amounts or types of fish oil might make a difference but at the moment this research doesn’t alter the current guidelines that specify fish oils are a good idea for certain heart failure patients and a reasonable option to consider for those who have already had a heart attack. For the rest of us, they certainly seem safe and are inexpensive, but whether they help actually help us keep healthy (from a cardiovascular sense) requires a bit of a leap of faith.