Given the potentially serious health concerns surrounding aspirin, why is this substance being heralded as a miracle drug in the fight against heart disease and worthy of the U. S. Government's stamp of approval? One reason is that aspirin is readily available over-the-counter; another reason is that one of aspirin's many properties is the inhibition of platelet clumping. Less clumping might mean fewer blood clots resulting in fewer heart attacks. Medical correspondent Wayne Martin writing in the Townsend Letter explains the Platelet Adhesiveness Index (PAI) test:

"At the National Heart Hospital in London circa 1970, they were using a test for platelet adhesion and the results were stated as PAI, platelet Adhesiveness index. In this test a blood sample was taken and a platelet count was made. Then a second blood sample was taken and this time the blood was passed over glass beads. If half the platelets stuck to the beads, PAI was 50. Patients who had survived a heart attack would have PAI of 50 and hence were considered to be at risk of death from a second heart attack. Young women who never suffer from Myocardial Infarction (MI) have PAI of 20 yet they will have proper blood clots in wounds.

At the National Heart Hospital, in the years 1960 to 1965, they did a PAI test on every patient to come to this hospital and they never found a single patient with PAI less than 40. They felt anyone with a PAI of less than 40 was not going to have a heart attack. Put another way, they felt that the great problem about MI was one of blood clots in coronary arteries.

The idea of testing for PAI never came to the USA. [5]

Because aspirin will reduce blood clotting, clinical trials were launched to find out whether aspirin may benefit heart patients. These trials have mixed results, none showing longer life; but two recent studies concluded that aspirin is a "life saver" because it cut down the number of non-fatal heart attacks, especially second heart attacks in the aspirin group.

Wayne Martin's interpretation of these trials:

"In 1980 cardiologists resurrected platelets and blood clots as a cause of Myocardial Infarction (MI) deaths - and told everyone over 40 to take aspirin to prevent having a heart attack. One factor in the prevention of MI is the Adhesiveness of platelets as the greater the adhesion of platelets the greater the chance of having a coronary blood clot.

Then came a series of trials on aspirin for the prevention of MI. There were in the 1970s two trials in England that were failures. No benefit or very slight benefit was found for aspirin in the prevention of MI. This was followed by a much larger US government-financed trial in the USA and reported in 1980. This trial was an abject failure with much bleeding of the stomach due to aspirin and no benefit at all in the prevention of MI.

Doctors felt that the case could be made for aspirin if only doctors were the subjects. A trial in England among doctors was again a failure, however a larger trial among doctors in the USA was hailed as a great success. In this American trial, non-fatal heart attacks were reduced by 40%. The bad news however, was that fatal heart attacks were not reduced and moreover overall survival was not increased. Nonetheless as the result of this trial, it was suggested or even demanded that all men over 40 should be taking aspirin.

There was something a bit different about this trial among doctors in the USA. Bufferin was used and Bufferin contains both aspirin and some magnesium. Magnesium is greatly beneficial to the heart. It reduces platelet adhesion, is a vasodilator and is a potent antiarrhythmic agent. [5]

The authors of The Arginine Solution, Robert Fried, Ph.D. and Woodson Merrell, MD, summarize the aspirin research this way:

"The results of the physician study, which were published in 1997 in The New England Journal of Medicine, concluded that a daily aspirin does indeed have a significant impact on heart health, lowering the risk of heart disease and heart attacks. Other researchers have also shown that aspirin can slash the risk of a second heart attack in patients who have already suffered a first heart attack. And because unchecked platelet clumping has also been implicated as one cause for chronic high blood pressure, aspirin and other anticoagulants may help in the treatment of hypertension as well.

"Unfortunately, many of these anticoagulant drugs, aspirin included, can have pernicious side effects for many patients, side effects that can range from serious stomach bleeding to kidney damage. Indeed, further analysis of the same landmark physician study itself found that those doctors in a control group who received a placebo instead of aspirin had the same overall incidence of death as those who received the aspirin.[2]

Surprisingly, Fried and Merrell question the validity of the claim that aspirin takers enjoy such a comparative reduction of heart disease and heart attacks:

"Well it turns out that physicians on aspirin increased their odds of another, often fatal condition: hemorrhagic stroke, that is, unchecked bleeding into the brain. This kind of stroke is a prime example of where you need some protective blood clotting, but the anticoagulants have turned of the capacity to do so".[2]

There Are Many Alternatives to Aspirin

Although aspirin apparently reduces the incidence of blood clots that lead to heart attack, much safer substances are known that work equally well or better:

"There are all kinds of things other than aspirin that reduce PAI, one of which is the drug dipyridamole. Here mention will be made of the European Stroke Prevention Study. About 90% of strokes are thrombotic strokes, blood clots in blood vessels in the brain. This trial had as subjects patients who had had an indication of a stroke. First aspirin alone was used with little or no benefit. Then dipyridamole was added to treatment, 300 mg a day and the results were outstanding. Stroke deaths were reduced by 50%, heart attack deaths by 35% and cancer deaths by 25%.

There are many things that reduce PAI better than aspirin. Vitamin E at 400 iu a day will, as will Vitamin B6 at over 40 mg day. There was an editorial in The Lancet a few years ago on how anti-thrombic is vitamin B6 at over 40 Mg. So is fish oil. This is the omega-3 fatty acid that we have been hearing so much about of late. Then recently, from the University of Wisconsin, comes a report that purple grape juice at 10 oz. a day will reduce PAI better than aspirin. It has been suggested that gamma linolenic acid in evening primrose oil will reduce PAI better than anything else. Also the oils of onion and garlic will reduce PAI. Ground ginger also is greatly effective in reducing PAI and like aspirin, it will reduce pain. It is highly anti-inflammatory. It is a sad state of affairs that doctors in the USA have gotten most men over 40 taking aspirin while not setting up a test to see if it is in fact reducing PAI. [5]

Arginine Derived NO Mediates Platelet Adhesiveness

One of the great discoveries stemming from the recent NO research is that the amino acid arginine may share an ability to prevent blood clots with aspirin, without any known risks. Scientists now think that NO derived from arginine regulates whether or not blood platelets clump together. If platelets were always clumping, The entire circulatory system would grind to a sludgy halt. Whenever a blood vessel suffers an injury, platelets clump together blocking blood from seeping out of the artery until the damage can be repaired. Clumps or clots that block coronary arteries can cause a heart attack. Something has to trigger clumping when it's called for, while inhibiting it when there is no need. It turns out that a number of blood-borne chemicals are released when an injury occurs that can alter electrical charges, and these chemicals determine whether or not platelets will repel or attract. According to Fried and Merrill, nature's elegant solution for regulating whether platelet's clump relies on the free radical Nitric Oxide (NO) made available in the body from arginine. [2]

"The good news is that researchers have found another "blood thinning" approach that is equally effective in controlling platelet aggregation, but without the side-effects of conventional anticoagulants from aspirin to leech saliva. This discovery came after Drs. M. W. Radomski, R. M. J. Palmer and Salvador Monacada learned that platelets themselves contain their own form of the enzyme nitric oxide synthase, which lets them create NO from arginine. [2]

Researchers now say that supplemental arginine can also help the hypertensive patient's remaining undamaged endothelial cells produce additional NO to keep arteries open and to prevent platelets from clumping and sticking to vessel walls. In 1994, researchers at the Hanover Medical School in Germany reported that intravenous arginine resulted in a 33 percent decrease in platelet aggregation - very impressive results. Moreover, the researchers concluded that arginine inhibits platelet aggregation specifically "by enhancing nitric oxide formation." [2]

In Theory, Aspirin may Aggravate Atherosclerosis

According to the Linus Pauling/Matthias Rath Unified Theory of cardiovascular disease, the primary cause of heart disease is a vitamin C deficiency. This deficiency leads to an inability to manufacture sufficient collagen, which causes blood vessel weakness and instability. Collagen is a basic animal protein that provides structural integrity analogous to the function of cellulose in plants. Blood vessel instability from a lack of collagen leads to lesions or wounds in the arterial wall, especially where blood pressure is high and mechanical stresses are great. Plaque forms as a healing response to these wounds.

It has long been known that taking aspirin increases one's requirement for vitamin C. Vitamin C molecules are used up detoxifying the body, so taking aspirin may lead to lower blood and tissue levels of vitamin C. According to Irwin Stone in 1976:

Certain drugs, such as aspirin, cortisone, and other anti-inflammatory agents, and cinchophen, are known to provoke ulcers and gastric hemorrhage. This is especially the case when a deficiency of ascorbic acid [vitamin C] is present. In animal experiments, the administration of ascorbic acid along with the toxic drug reduced the incidence of peptic ulcer and gastric hemorrhage to such an extent that it prompted one author (Aron) to suggest, "Therefore it would seem judicious in human therapeutics to include ascorbic acid in every prescription for an anti-inflammatory drug"[6].

Aspirin's ability to dissolve human tissues would seem to make this substance contraindicated in atherosclerotic patients. If Pauling and Rath are correct and the lack of vitamin C causes heart disease, and if aspirin can cause blood vessel lesions, and finally, if the body uses its vitamin C stores to "fight" the toxic effects of aspirin, then taking aspirin may be the last thing a heart patient should do.

Arginine May be the Best Alternative

Most authorities now accept the proposition that heart attack is not generally a problem of arterial occlusion; rather MI is a problem of blockage. The problem with occlusion is that blockages are more likely in arteries narrowed by atherosclerosis. When platelet adhesiveness increases, the risk of heart attack rises. Nitric Oxide causes arteries to dilate and blood pressure to drop. Interestingly, the research shows that atherosclerosis interferes with the ability of endothelial cells to make NO, so clotting is more likely when atherosclerotic plaque is present. If a blood clot is the reason for the blockage, thinning the blood with an anti-coagulating agent may be of significant value. The discovery that NO derived from arginine regulates blood coagulation at the platelet level is important. Arginine has been shown to have the same anti-clotting ability as aspirin, but not continuously, only when needed, i.e., when chemicals associated with injury are released into the blood stream. Aspirin's health risk is that this substance may unconditionally prevent blood coagulation, even when clotting is called for, e.g., to prevent a stroke. Furthermore, aspirin's known characteristic of dissolving tissue may not be limited to the stomach. If aspirin causes arterial lesions, then it would be a contributing factor in atherosclerosis.

The Final Word from Linus Pauling

While rethinking your daily aspirin, please consider these remarks made by the late chemist and medical researcher Linus Pauling writing in HOW TO LIVE LONGER AND FEEL BETTER:

"It is drugs, especially the analgesics and antipyretics such as aspirin, that are responsible for most of the five thousand deaths by poisoning that occur each year in the United States. Of that mournful total about twenty-five hundred are children. About four hundred of these children die each year of poisoning by aspirin (acetylsalicylic acid) and some other salicylate. Aspirin and similar drugs are sold openly, without prescription. They are considered to be exceptionally safe substances. The fatal dose is 0.4 to 0.5 gm per kilogram body weight: that is 5 to 10 gm for a child, 20 to 30 g for an adult."

"Aspirin has been in use as a nonprescription drug, sold casually over the counter, for more than a century before the physiological basis of its pain killing and fever-reducing action was discovered in 1971. Then it was found that aspirin acts upon a central hormonal control system in the body. If it were now coming on to the market from a pharmaceutical laboratory, it would be surely placed under the constraint of prescription.

"Some people show a severe sensitivity to aspirin, such that a decrease in circulation of the blood and difficulty in breathing follow the ingestion of 0.3 g to 1 g (one to three tablets.)

"The symptoms of mild aspirin poisoning are burning pain in the mouth, throat and abdomen. Difficult in breathing, lethargy, vomiting, ringing in the ears, and dizziness. More severe poisoning leads to delirium, fever, sweating, incoordination, coma, convulsions, cyanosis (blueness of the skin), failure of kidney function, respiratory failure, and death.

"Aspirin, like other salicylates, has the property than in concentrated solution it can attack and dissolve tissues. An aspirin in the stomach may attach the stomach wall and cause the development of a bleeding ulcer.

"The U. S. Centers for Disease Control have reported that if children and teenagers suffering from influenza or chicken pox are given aspirin they have a fifteen to twenty-five times greater chance of developing Reye's syndrome, an acute encelphalopathy and fatty degeneration of the viscera, causing death in about 40 percent of the patients." [2]

Should you decide, in consultation with your physician, to replace your daily aspirin with 3-6 grams of oral arginine, you may notice some other interesting effects as well. One effect in particular may negate the need for men to spend upwards of $10 on a Viagra pill.

Owen R. Fonorow PO Box 73172 Houston, Texas 77273 fonorow@foxvalley.net http://www.vitamincfoundation.org

REFERENCES

1. Klatz, Robert et. al., Grow Young with HGH, (1998)
2. Pauling,Linus, How to Live Longer and Feel Better (1986)
3. Fried & Merrell, The Arginine Solution (1999)
4. Kelly et al, The Lancet, 348 (1996), 1413-1416
5. Martin, Wayne, Townsend Ltr, (1998)
6. Stone, I. The Healing Factor: Vitamin C Against Disease (1976)