Should you take a daily baby aspirin? And more.

This month, Dr. Sydney Spiesel discusses whether to take a daily baby aspirin, the sudden deaths of young athletes, the spinach scare, and the link between sugar and behavioral problems in kids. (Click here and here for his last two columns.)

Daily baby aspirin: your stomach vs. your heart

Daily dose: Like many people my age (I get some senior discounts), I pop a daily baby aspirin tablet of 80 mg, or the equivalent of one-quarter of an adult tablet. I do it to reduce my risk of heart attack by 25 percent or 30 percent (check your heart attack risk at this site) and to possibly reduce my risk of colon cancer, but mainly because my personal physician thinks it's a good idea. Every once in a while, I wonder whether the benefits match the risks (this is a tough universe, you know). I had that thought a few weeks ago, when I encountered a friend, another doctor, at a party. His foot and lower leg were in a cast. He'd done something foolishly athletic and damaged a tendon, but the real problem, he said, was his daily baby aspirin. Because of its effects on blood clotting, the aspirin led to a lot of local bleeding and swelling.

New research: Now a new study points out that taking aspirin poses risks to the stomach and upper digestive track—specifically, of a higher probability of serious upper-gastrointestinal bleeding or perforation. This risk needs to be balanced against the potential benefit of heart-attack prevention. The authors are Sonia Hernández-Díaz of the Harvard School of Public Health and Luis García Rodríguez of the Spanish Center for Pharmacoepidemiological Investigation in Madrid. They made use of two large clinical databases: the UK's General Practice Research Database, which includes clinical information about roughly 3 million patients, and a similar Spanish database of more than a million patients.

Competing risks: The competing risks of heart and GI problems aren't uniform. Some people are at unusually high risk for heart attack, a risk much higher than that of GI bleeding or perforation. For that group, the optimal strategy is clear—take your aspirin. Conversely, the study identifies a group of patients whose risk of heart attack isn't especially high. For those people, the optimum strategy might well be to forego daily aspirin treatment. Factors known to affect the risk of heart attack include age, male gender, blood pressure, cigarette smoking, diabetes, cholesterol level, and previous diagnosis of cardiovascular disease. In the new study, increasing age, male gender, and ulcer history were risk factors for GI complications.

Findings: The researchers found that daily low-dose aspirin approximately doubles the risk for each of these factors. At the low-risk end of the spectrum—female patients under 60 years old, for instance—aspirin adds only a small amount of risk for GI bleeding or perforation. At the high end—male patients in their 80s with a complicated ulcer history—aspirin leads to 150 more cases of GI complications per 1000 people in the course of a year.

Conclusion: This number is vastly higher than the number of heart attacks the aspirin might be expected to prevent. It's probably a strong argument against using aspirin to prevent cardiovascular disease in high-GI-risk populations. In short, this study gives us a more rational way to plan preventive treatments for heart disease. Since I'm not in a high-risk group for GI problems, I'm going to keep taking my aspirin.

Sudden death in athletes

Problem: Like every pediatrician, I am regularly called on to clear youngsters for athletic participation. Many elements of the required physical exam are probably not worth much. But we all march through the ritual and then check the boxes on the form. More often from taking a good history than from the physical exam, we occasionally find something to worry about. But the exam isn't likely to identify the greatest danger: the possibility of sudden cardiovascular death.

Cause: Mostly, these deaths are due to an unrecognized structural defect in the heart, in particular cardiomyopathy. This condition has multiple causes, including congenital defects and high blood pressure (both of which place excess demand on the heart muscle) and certain viral infections (which diminish the heart's ability to respond to normal demands). Often a heart with cardiomyopathy develops an irritability that leads to abnormal rhythms. These, in turn, interfere with proper pumping functions—sometimes fatally.