Aspirin is making a comeback. After having been relegated to the back of the medicine cabinet, its pain relief properties, seen as second to ibuprofen and acetaminophen, the once cure-all is experiencing a resurgence, this time as a preventer of heart disease.Dr. Sreenivas Gudimetla, a cardiologist at Texas Health Harris Methodist Hospital Fort Worth, regularly recommends a daily dose of aspirin to patients at risk for heart problems. We talked with him about the drug’s benefits and how to use it. What makes aspirin good for your heart?What aspirin actually does is it serves as a blood thinner. More specifically, the first step in blood-clot formation within a heart artery that causes heart attacks is a structure within the blood called platelets. What platelets do is they sort of aggregate and they clump together, and when a cholesterol plaque that builds up in the heart arteries is disrupted due to an injury within the vessel, it leads to a blood-clot formation and a heart attack. Aspirin actually blocks that process from occurring. So in essence, it thins the blood to protect the heart from injury due to lack of blood flow through the heart artery. Many people think of aspirin as a pain reliever. Are the blood-thinning properties just a side benefit?Yes. As we all know, for years and years, aspirin has been used as a pain reliever. I still see old commercials from the ’50s with aspirin being advertised for that. But we’ve learned, probably within the past 20 years, that aspirin has a significant benefit in reducing heart attack risk, especially in those individuals that have multiple risk factors, or that have established heart disease, because of this blood-thinning effect that none of us were aware of some 20 years prior. So is it recommended that we all take aspirin regularly? I don’t think right now we have any evidence to recommend aspirin all across the board in everybody to prevent heart disease. Aspirin should definitely be used in select individuals, people who have high risk for heart disease or people who have had a history of heart disease or have had other types of blood vessel disease. It is recommended as a long-term therapy in high-risk people. So people who have had a heart attack or who have a history of heart disease are considered high-risk. Who else?Typically aspirin is recommended in men over 45 and women over 55 — that’s according to the U.S. Preventive Services Task Force recommendation statement. Basically, it’s as long as the benefit in terms of prevention of cardiovascular disease outweighs the risk of gastrointestinal hemorrhage. One of the side effects we need to keep in mind is that aspirin can cause stomach upset that may lead to ulcers. But in my clinical practice I hardly ever see that as a major concern.I also think it’s appropriate to recommend aspirin in people who may have never had a cardiovascular event but are at risk for having a cardiovascular event. People with diabetes, for instance, even if they’ve never had a heart attack, we treat them as though they have cardiovascular disease, because they essentially do.Other risks where you should consider taking aspirin earlier on is people who are active smokers; people who have a family history of premature coronary artery disease, defined as men who have had a heart attack at less than 55 or women at less than 65; people with hypertension; people who have cholesterol abnormalities; people who are overweight or not living healthy lifestyles — anything that can lead to the risk of coronary artery disease, you can make the argument that they can take a baby aspirin a day.My approach is to individualize how early you start aspirin on the basis of one’s own individual profile and risk factors. Definitely talk to your doctor to see what’s right for you. Is it just aspirin, or do other over-the-counter painkillers do the same thing?When we talk about aspirin we really do mean specifically aspirin. Aspirin actually has that direct platelet-blocking effect that other medicines, like Tylenol and ibuprofen, do not have. How often and how much aspirin should those with risk factors be taking?We recommend daily, and, in most cases, a baby aspirin is plenty — 81 milligrams once a day. You do get adequate platelet inhibition with just that dose. What about taking aspirin if you feel chest pains or are showing symptoms of a heart attack?In most cases we do recommend it. Certainly when people have taken aspirin and have aspirin on board and come in and are actually having a heart attack, it does have incremental benefit in terms of potentially limiting the size of a heart attack. When people come having a heart attack, come into the emergency room, one of the first things we do is have them chew an aspirin to try to get it into the system as quick as possible.