PITTSBURGH -- Last November a mild heart attack changed the way John Mastromarino protects himself. Now he takes a simple daily aspirin as part of his armor. “325 milligrams-- I’ve been taking it every day since.” It’s ironic, but John knew about aspirin although he never took it seriously. “I had intermittently taken the 81 milligrams, and then I’d run out and never refill.”

Studies show no doubt aspirin protects against heart attacks. Millions of Americans take an aspirin a day for just this reason. Many doctors believe practically everyone should get an aspirin a day starting at around age 40-45. What is often prescribed is an enteric coated 81 mg. baby aspirin. But there are questions that remain. For example, should a person use an 81 milligram baby aspirin, or a 325 milligram adult aspirin? And there’s also the question, how much does enteric coating lower the effectiveness of an aspirin?

Now, new research shows enteric coated aspirin is less potent than plain aspirin, which may make it less effective at preventing heart attacks. Dr. James Januzzi is a cardiologist at Massachusetts General Hospital. He says, “This is probably of the first studies to show this exact finding so it catches a lot of us by surprise, and if true it will really change how we manage patients.” Januzzi says perhaps, though, the enteric coating is not the real problem. Rather, because around 30% of us are naturally resistant to aspirin, maybe the enteric coating is simply bringing out that decreased responsiveness.

The researchers make a very strong point that patients should absolutely not change either the dose or the type of aspirin they are taking without first talking to their physicians. They did say that heavier patients should pursue discussions with their doctors as to whether they should be on a regular aspirin instead or on a higher dose of enteric coated aspirin.

Still, many experts, including Dr. Januzzi, will argue enteric coating is important for minimizing the side effects--stomach irritation and bleeding. Januzzi wants to see more studies. He argues, “Some patients cannot tolerate even the lowest doses. Enteric coating really minimizes these side effects. Therefore it is very valuable in my opinion because it allows us to treat many more patients than we might not have been able to treat.”

John is satisfied with the way doctors managed his case--325 milligrams of enteric coated aspirin each day. ‘I was fortunate because they caught the blockage before it did any damage. I was one of the lucky ones.”

Visit these links for more information:
Agency for Healthcare Research and Quality
National Heart, Lung and Blood Institute