Aspirin may help prevent heart attack... but not for everyone. Aspirin is often recommended to help prevent heart attacks and strokes in people susceptible to cardiac problems. However, this drug can produce several unpleasant side effects in some patients, including stomach upset and internal bleeding.

Researchers at the Minneapolis Heart Institute studied 4,229 subjects who were participating in the Multi-Ethnic Study of Atherosclerosis (MESA). After seven years of tracking, investigators found that patients who have greater concentrations of coronary artery calcium (CAC) are likely to receive the greatest benefits from aspirin therapy. None of the subjects was undergoing aspirin therapy at the start of the study.

Scans are performed to measure the levels of calcium in major blood vessels. The study showed that for patients with significant risk levels and CAC counts over 100, aspirin could be a vital part of a healthy cardiac regime. For people with lower calcium levels, or at less of a risk for a cardiac event, side effects of the drug may make aspirin a poor choice of medicine. Aspirin could be two to four times more effective for cardiac health among those with high CAC counts, compared to those with lower calcium levels. 

"Approximately 50% of middle-aged men and women have a CAC score of zero, so there is a potential for this test to personalize the approach to prevention and allow a significant number of patients to avoid preventive medications, but we need further research to verify that routine use of this test is the best option for our patients," Michael Miedema, lead author of the article announcing the research, told reporters. 

Aspirin helps those at risk from cardiac events by preventing blood clots from developing in plaque-filled arteries. It does this by blocking an enzyme required for clots to form. Researchers in the study found this build-up was far more predictive of heart attacks and strokes than either high cholesterol or a family history of heart disease. 

An aspirin a day may still be a great idea for some patients. However, not everyone is likely to benefit from the drug. Thanks to this new research, it is possible to determine the effectiveness of the regime before it begins. This could allow healthcare workers to pursue other treatment methods for those with unfavorable calcium levels. 

Study of CAC scores and their relationship to aspirin therapy for cardiac patients was profiled in the journal Circulation: Cardiovascular Quality and Outcomes

The Food and Drug Administration (FDA) spoke out against the study, saying people without a history of heart disease should focus on reducing cholesterol and blood pressure. That agency recently prohibited Bayer from marketing its product as a drug capable of preventing heart attacks in healthy subjects.

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