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Cardiovascular disorders are becoming the major cause of mortality and morbidity in the modern world (Sirbu & Linton 2017). This is evident from the increasing number of hospitalizations, death, and treatment costs. Despite the advanced medical therapies and the rising longevity of people, the incidence of heart disease is attaining appalling proportions (Zipes et al. 2018). The main reason for such a situation is that heart attacks and strokes occur unexpectedly, allowing the ensuing symptomatic events lead to sudden hospitalization and probable death. Mostly, the primary medical intervention in such cases is the use of aspirin. Though it has been substantially proved that is effective in patients with a history of heart attacks or strokes, its role as a primary preventive medicine is not yet evidenced (Karmali & Huffman 2017). This research paper, therefore, tries to find out how far aspirin is effective in preventing heart disease in the context of ongoing progress in medicine administration and medical ethics.
2. Causes of Heart Disease
Heart disease occurs when the parts of the heart and coronary arteries are damaged and there is a poor supply of oxygen and nutrients to the organ. The lifestyle choices and the outcomes can become a catalyst for the risk of heart disease. Smoking, obesity, diabetes, high blood pressure and cholesterol, family history, junk food, age, preeclampsia in pregnancy, and long staying in a stationary position are risk factors of heart disease (Felman, 2018). Heart diseases are of different types, and most of them need medical intervention, apart from lifestyle changes. Diseases, like Coronary Artery Disease (CAD), Heart Arrhythmias, Heart Valve Disease, Heart Failure, Pericardial Disease, Cardiomyopathy and Congenital Heart Disease are some of them, requiring medical treatment (Steinbaum 2017).
The heart disease, otherwise known as cardiovascular disease, is caused by the narrowing of the blood vessels that lead to heart attack, angina, or stroke. Other conditions, like the disorder of the heart’s muscles and valves, are also considered as heart disease. The development of coronary heart disease is associated with the volume and accumulation of platelets in the blood. Since the coronary arteries network on the heart’s surface is responsible for the supply of oxygen to the heart muscles, their blocking will interrupt the supply of oxygen-rich blood to the heart. This disruption will enable the plaques to accumulate, which is otherwise known as atherosclerosis (Nordqvist 2018).
Atherosclerosis is known to be the cause of all coronary artery and peripheral arterial diseases and strokes. It is characterized by the growth of lipids and macrophages/lymphocytes within the arteries. These fatty plaques are vulnerable to rupture and therefore, the disruption tends to compel the platelets to aggregate on the vascular surface. When there is an injury, the plaque deposits around it will join together, initializing the clotting cascade to undergo the atherothrombotic process (Badimon et al. 2018), making the platelets to do the repairing of the blood vessel. Their accumulation is what blocks the artery, ultimately ending up in a heart attack (Nordqvist 2018).
Heart Disease continues to record its presence in its aggressive forms because of the growing longevity of people. The recent studies have affirmed that it is the leading cause of stroke in the elderly. Several monitoring devices like ECG adhesive sensors, smartphone attachments, wearables, and implantable loop records were clinically validated and employed for supporting such people (Singh et al. 2018). It is estimated that 14 million people in Americal suffer from coronary artery disease (CAD), including congestive heart failure (CHF), arrhythmias, and angina. Most of these people have to undergo surgical procedures, as well as cardiac rehabilitation to overcome their CAD (Sirbu & Linton 2017). The gender differences in heart diseases are pervasive, leaving the women underrepresented in the clinical trials and management of cardiac diseases, as well as in the use of drugs (Mehta & McSweeney 2018).
3. Changing Therapies
Though much attention is given to the cardiac dysfunction in patients who are making progress of infection in sepsis, the processes are still limited. The release of nitric oxide, cytokines, and prostanoids are worsening their conditions (Sergi et al. 2017). The use of CVD precision medicine for improving the vascular outcomes in responsive patients could become a positive step in overcoming the problems faced by the cardiac-patient population. Innovations in genetics seem to be a milestone in precision medicine, though the inherited genome can contribute less to a patient’s risk profile. The epigenetic modifications or the heritable alterations to the genome, without changing the DNA sequence have streamlined the biological regulation of CVD. This makes it easier for a better-individualized risk assessment for developing and executing tailored therapies (Costantino, et al. n.d.). Though the addition of rivaroxaban to aspirin in patients with coronary artery disease has the potential to lower major vascular events, it could cause severe bleeding (Connolly et al. 2018).
4. Prevention of Heart Attack
Heart attacks happen, subsequent to a short but squeezing discomfort in the chest. Other symptoms include pain in the neck, arms, jaw, and stomach, and also shortness of breath, sweating, and nausea (AHA 2018). The disorder develops when the blood supply to the heart muscle or the brain is blocked, causing atherosclerosis, in which fatty substances, cholesterol, calcium, and other microcellular waste products accumulate in the artery to make the plaque. These growing plaques reduce the blood flow in the artery and become fragile and rupture, leading to blood clots. When the blood clots block the arteries, a heart attack occurs. Aspirin can help prevent the blood clots and the resultant heart attacks (AHA 2018).
In certain cases, an aspirin combined antiplatelet drug is given to alleviate heart attack or stroke (AHA 2018). The American Heart Association recommends that people having a higher risk of heart attack should take low-dose aspirin every day, as advised by the physician (AHA, 2018). Recent researches also indicate that taking an aspirin a day is good for the people having Type 2 diabetes and heart failures for lowering the risk of dying. However, in contrast, aspirin use could increase the incidence of nonfatal heart attack or stroke (ACC 2018). According to Caman, 2018, anticoagulation for 3 to 6 months and beyond should be given to those patients with deep vein thrombosis and pulmonary embolism, having a tendency to repeat the event. An ongoing therapy can be initiated by using clinical risk stratification protocols and biomarker analysis (Caman 2018).
5. How aspirin works
Aspirin prevents the aforesaid clot formation of the platelets (Karmali & Huffman 2017) and is one of the common drugs used for the treatment of heart diseases. It is a non-steroidal anti-inflammatory drug, having varied pharmacological functions, such as analgesic and antipyretic, as well as the antiplatelet properties. Aspirin is acetylsalicylic acid and is known to be in use since B.C. 1,500. The body immune system develops the control mechanisms in the event of an injury, by producing lipid mediators, such as lipoxins, maresins, resolvins, and protectins from arachidonic acid (AA) or polyunsaturated fatty acids. This is accomplished through the transcellular biosynthesis with the help of different enzymes. Aspirin helps in the production of certain pro-resolving lipid-derived mediators that are analogous to the endogenously produced ones that are conducive to the resolution of inflammation, along with its analgesic, antipyretic, and antiplatelet properties. However, the efficacy and empirical use of this compound, as a preventive medicine are still in a shroud (Angela 2018).
Though Aspirin has been in use as a household medicine for fever, pain, and inflammation, it was on only in 1971 that it was found to suppress the production of eicosanoids. Later it was proved that aspirin reduces thromboxane formation and has antithrombotic effects, along with its potential in the prevention of cardiovascular diseases, like myocardial infarction, strokes, and other atherothrombotic occurrences (Angela 2018). Several other research trials for testing the aspirin effects in people having no history of heart attack or stroke have unequivocally evidenced that aspirin has got the potential to prevent nonfatal heart attacks and strokes. But, at the same time, it has also been established that there was no marked effect on cardiovascular death (Karmali & Huffman, 2017).
A 2017 trial conducted by the “Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes” (JPAD) has proved that Aspirin lacked any long-term potential in preventing cardiovascular events in type 2 diabetes mellitus patients and that its administration in the patients has only increased the risk for gastrointestinal bleeding (Yoshihiko et al. 2017). The atrial fibrillation (AF) and heart failure have increased fivefold in the last decade and various trial results have established that the administration of aspirin in the prevention of thromboembolic complications has only a lesser mortality benefit (Thihalolipavan & Morin 2015).
5. Effects of Aspirin
The most important adverse effect of aspirin is bleeding and is affected mostly in the intestines. It can also occur in other prominent locations, such as the brain. The gravity of risk of Aspirin bleeding is more in the males and elderly people. Persons having stomach ulcers and those using anti-inflammatory medications, such as ibuprofen or corticosteroids for long-term are vulnerable to Aspirin. Similarly, the people who are long-term users of anticlotting drugs, like warfarin and clopidogrel are also at risk of bleeding. In order to reduce the risk of bleeding from aspirin, only a low-dose aspirin of 75 to 100 mg is recommended as a means of primary prevention in the treatment of heart disease (Karmali & Huffman 2017).
6. Areas where aspirin should not be used
Aspirin should not be taken when the patient is allergic to aspirin or if it worsens the condition of the patient. Taking aspirin is not at all advised during a stroke, because they are not always caused by blood clots. Ruptured blood vessels are also responsible for heart attacks. Taking aspirin could potentially make these bleeding strokes more severe. It is not recommended to take aspirin if there is a risk for gastrointestinal bleeding or hemorrhagic stroke. Aspirin should be avoided in the alcoholic patients and during the period when the patients undergo medical or dental procedures (AHA 2018).
7. Ethical implications of using aspirin for heart disease
Illness is a subjective experience of the patient about his/her state of being unwell, sharing the psychological, ethical, and social dimensions that are interlinked within a particular culture. As such, the physicians, being the trustees of the patients, should listen to the second opinions, prior to prescribing aspirin. Generally, the assumption is that whatever decision the physicians take is acceptable. That means the decision making power in the clinical practice is paramount for the patient, which should be adhered scrupulously (Barritt 2015). The clinical practice guideline (CPG) underlines this medical standard. The guideline suggests that problems could arise, due to the over-credulity on the randomized clinical trial (RCT) results, and that too when making recommendations where the RCT evidence is lacking (Lee & Jeong 2017). This situation demands a relationship-based approach while incorporating health law on controversial topics (Mark et al. 2018), such as the development of competition drugs. This explains the use of aspirin during the World War I and the invention of ibuprofen in the later years. This is also the foundation for the application of aspirin for treating heart disease in the 1950s and 1960s (Rooney & Campbell 2017).
8. Efficacy of Aspirin
Considering the uncertainty that exists in determining the benefits and the adverse effects of applying aspirin in the primary prevention of cardiac disease, the US Preventive Services Task Force (USPSTF) has released relevant guidelines in 2016. Accordingly, any attempts to personalize treatment decisions shall be made only after recognizing the shared decision making between the patients and the clinicians. That agrees with personalizing the treatment decisions, in accordance with the assessment of therapeutic benefits, as well as probable adverse effects. This is in relation to the patient preferences and values. Therefore, to agree with the USPSTF guidelines, low-dose aspirin therapy should be employed only in willing adults who are aged 50 to 59 years, having a 10-year risk of cardiac arrests, without any rising bleeding risk. It also stipulates that such patients should have a minimum 10-year life expectancy (Karmali & Huffman, 2017). In spite of what has stated above, Wolf et al., 2018 points out that when the key factor of CVD and thromboembolism prevention is resting with aspirin, its use in non-cardiac surgery, subsequent to aspirin therapy is unwarranted (Wolf et al. 2018). Thus, the observation of the USPSTF that enough material evidence is still wanting is standing, till a future research into the administration of aspirin for adults, less than 50 years and older than 70 years, confirms its sanctity (Karmali & Huffman, 2017).
Heart disease is the cause of major mortality and morbidity in the modern times. The tragic aspect of the disease is that its symptomatic events culminate in the immediate hospitalization and probable death of the patient. In most cases, the problem is the clotting of the blood in the heart muscles and coronary arteries. Since aspirin possesses the ability to thin the blood, it is widely used in the primary medical intervention for cardiovascular disease. Though it is effective in patients with a history of heart attacks or strokes, no researchers have proved its role as a primary preventive medicine for CVD, through clinical trials. Therefore, it is concluded that using aspirin as a preventive medication for heart disease is questionable in the ethical perspective.
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