Aspiring Aspirin 
Aspirin, with its anti-inflammatory powers, would seem to be an ideal ally in reducing your heart risk while managing your arthritis. And in Dr. Pearson's opinion, it is. 

"Aspirin prevents heart disease. Period," says Dr. Pearson. "We like the stuff." It's not clear whether aspirin's heart benefits are due to its anti-inflammatory action or its blood-thinning effects, but it's definitely on the American Heart Association's (AHA) A-list, too. Along with other recommendations for people at higher risk for heart disease and second heart attacks, the AHA advises taking 75 to 325 milligrams of aspirin a day. But not everyone seems to be getting the heart association's message about the benefits of aspirin and other risk-reducing medications. In a study of 2,763 postmenopausal women with coronary heart disease, researchers found that those at highest risk were least likely to be using preventive medications.

"Of those who took preventive medications, aspirin was the most widely used; but the other preventive treatments -- beta blockers and ACE inhibitors, which lower blood pressure, and statins, which decrease cholesterol -- were seriously underused," says Stephen Hulley, MD, of the University of California, San Francisco, one of the lead investigators on the project. "What's more," says Dr. Hulley, "the women that had the highest risk actually were less likely to be taking aspirin and lipid-lowering drugs than the women at more moderate risk. So there's a lot of room for improvement."

If you're already taking aspirin, that's good -- probably. But some people who are dutifully popping aspirin tablets to ward off heart disease and stroke may not be getting the protection they think they are, warns Mark Alberts, MD, of Northwestern Memorial Hospital in Chicago. Dr. Alberts and colleagues measured how well different doses and formulations of aspirin thinned the blood of patients with cerebrovascular disease, such as stroke and other conditions that may lead to stroke. They compared baby aspirin with adult aspirin and coated tablets with uncoated tablets. The result?

"A high percentage of patients taking either baby aspirin (81 mg) or coated aspirin (325 mg) showed no blood-thinning effect," says Dr. Alberts. "There also was a trend for people older than 63 to show less of a response than younger people,
independent of aspirin dose or coating." 

If these preliminary results are borne out in larger studies, doctors might start using quick and inexpensive FDA-approved tests, called platelet function assays (PFAs), to monitor patients' responses to aspirin therapy and adjust their dosage accordingly, Dr. Alberts predicts. You might discuss the PFA test with your doctor, says Dr. Alberts, if you take coated aspirin to relieve the pain of RA and to protect yourself from an ulcer, and you want to make sure you're getting blood-thinning benefits. 

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