Read the following account from a student’s draft report on the topic of the
prevention of coronary heart disease using aspirin.
Cardiovascular disease (CVD) refers to any disease that affects the cardiovascular
system, principally cardiac disease, vascular diseases of the brain and kidney and
peripheral arterial disease. Coronary heart disease is a common type of heart
disease and is the leading cause of death worldwide. It is responsible for around
73 000 deaths in the UK each year. The disease is caused by plaque building up
along the inner walls of the arteries of the heart, which narrows the lumen of the
arteries and reduces blood flow to heart tissue.
An estimated 83.6 million American adults have one or more type of CVD.
Of these, 42.2 million are estimated to be at least 60 years of age. A diet high
in saturated fat increases the risk of heart disease and stroke. It is estimated to
cause about 31% of coronary heart disease and 11% of strokes worldwide. If it
runs in your family, there is also an increased risk.
Aspirin is a drug used for medical purposes. It has many uses, especially for
preventing blood clots in the arteries and veins, giving it an important role in
preventing strokes and cardiovascular disease.
When a person gets a cut or scratch, platelets release thromboxane, a chemical
that signals other platelets to join and help to form a clot. However, if you are
a stroke survivor, thromboxane’s ability to help to form a blood clot becomes
life-threatening.
Research has shown that a low dosage of aspirin can prevent cardiovascular
events in people who have already had a heart attack, certain kinds of strokes
or other diagnosed cardiovascular disease. In a group of 10 000 such people,
aspirin can prevent 250 cardiovascular events, such as heart attacks and strokes.
However, in the same group, 40 cases of serious bleeding occurred. The ratio of
risk to benefit is roughly six people helped for every one harmed.
A randomised trial was done for primary-prevention to see the effects of aspirin
on heart attack. 22 071 healthy male patients were given 300 mg of aspirin every
other day. There was a 44% reduction in the risk of a first heart attack.
A study involving 144 051 patients was carried out. The research showed that of
the 71 912 patients given aspirin, 7705 had serious vascular events. 72 139 patients
were given a control treatment and 9502 of these had serious vascular events.
Although the use of aspirin has its advantages, there are some implications
to be considered. The trials involve the use of animals. This means that the
animals could potentially suffer from stomach bleeds and bowel irritation. It
can be considered unethical to use animals for drug testing because, as complex
organisms, they can feel more pain due to a more sophisticated nervous system.
Also, they are unable to give consent to these types of procedure.
There are also the side effects of aspirin to take into consideration. Aspirin could
cause patients to feel indigestion and there is an increased risk of bleeding. This
can be costly for the health services. Aspirin tablets are cheap. 32 tablets, each
containing 300 mg of aspirin, cost 0.75 USD (United States Dollar). However, the
cost per transfusion is 400 USD.
One alternative to aspirin is the use of the drug heparin. Heparin is used
as an injectable anticoagulant. Anticoagulants reduce blood clotting. This
means blood clots are less likely to form at sites of damage in artery walls.
Anticoagulants can be used to treat patients who already have cardiovascular
disease. They prevent any existing blood clots from growing any larger and
prevent any new blood clots from forming.
A double blind test was carried out on aspirin and heparin. Heart attacks during
the study period occurred in 2 (0.8%) of the 240 patients in the heparin group and
in 9 (3.7%) of the 244 patients in the aspirin group. There are many side effects of
heparin, which causes aspirin to be better. Side effects of heparin include blood
in the urine, constipation, dizziness and many more.
Another alternative is the use of statins, which are a group of medicines that help
lower the level of low-density lipoprotein (LDL) in the blood. Having a high level
of LDL is potentially dangerous, as it can lead to atherosclerosis. Statins cost an
average of 228.78 USD a year per patient. The NHS bill for statins in 2004 came
to 1153 million USD. Meeting this cost could mean diverting money from other
treatments or even increasing taxes.
Statins also have side effects including muscle pain and damage, liver damage
and increased blood sugar or type 2 diabetes, along with quite a few less
common problems.
State the main problem identified in this report.