1.Is aspirin taken before or after a meal? The traditional use of aspirin in general is to take it after meals, aiming to reduce the direct damage to the gastrointestinal mucosa through the buffering of food. However, enteric aspirin is acid-resistant but not alkali-resistant, so if it is taken after a meal, it does not reflect the advantages of enteric tablets. This is because the buffering of food after a meal dilutes the acidic environment in the stomach and increases the pH of gastric juice, which makes the enteric coating easy to dissolve; in addition, the mixing of tablets and food prolongs the stagnation time of the drug in the stomach, which also makes it easy to destroy the enteric coating. When taken before meals, the acidic environment in the stomach is strong in fasting, the enteric coating is not easy to dissolve and the gastric emptying speed is fast, so the residence time in the stomach is short, which can reduce the damage of the drug to the gastric mucosa. Observational studies have also confirmed that the incidence of gastrointestinal adverse reactions can be significantly reduced by taking enteric aspirin before meals. For patients with epigastric pain, burning sensation and other discomfort symptoms after taking aspirin enteric tablets after meals, most patients no longer have gastrointestinal discomfort symptoms after taking the drug 20-30 min before meals. Therefore, it is recommended that aspirin enteric tablets be taken before meals to reduce the damage to the gastric mucosa. 2.Should enteric tablets be given “not chewed”? The most common way to take aspirin enteric tablets is orally, 100 mg per day, with appropriate amount of water before meals. Since aspirin enteric tablets are acid-resistant, they do not dissolve in acidic gastric juices but dissolve in alkaline intestinal juices. The absorption of aspirin enteric tablets is delayed by 3 to 6 hours compared to regular tablets. When a patient presents with suspected acute myocardial infarction onset: an initial dose of 300 mg, chewed, is recommended for rapid absorption (not limited to enteric aspirin). Therefore, in general, it is not necessary to explain “not to chew and take” to avoid misunderstanding by patients and delaying self-help at the onset of acute myocardial infarction. 3. Is there still a risk of gastrointestinal bleeding when taken before meals? High-quality aspirin enteric coating dissolves only in the alkaline environment in the duodenum, thus avoiding direct damage to the gastric mucosa. However, it does not significantly reduce the risk of gastrointestinal bleeding. In addition to the direct damage to the gastrointestinal mucosa, aspirin inhibits cyclooxygenase (COX) activity, reduces the synthesis of prostaglandin, a protective factor of the gastrointestinal mucosa, decreases the synthesis of thromboxane A2, and reduces the aggregation ability of platelets, which predispose to bleeding. Gastrointestinal adverse reactions caused by aspirin range from mild dyspepsia to fatal peptic ulcer bleeding and perforation. Studies have shown that aspirin can increase the risk of GI injury by 2 to 4 times. The absolute risk of serious GI bleeding from aspirin is 0.12% per year. Aspirin is best taken on an empty stomach to shorten the residence time in the stomach and smoothly reach the absorption site in the small intestine. However, the prerequisite is to use enteric-coated enteric aspirin tablets, which are more advantageous to import. We recommend individualized medication under the guidance of a doctor, forbid unauthorized use of drugs! Next, let’s get to know this century-old legendary drug aspirin from a new perspective! Aspirin is an amazing medicine that is over 110 years old. It is called “the three classic drugs in the history of medicine” together with penicillin and Valium. It provides a simple, effective and economical means to reduce death and extend life expectancy, especially in heart attacks. From the moment it was born, the debate around it has never stopped, but in the prevention and treatment of cardiovascular disease, the consensus among doctors is – it should be used. Painkiller found in willow bark The first recorded story about aspirin in Western medical history began in 1897. But in reality, the storied history of aspirin is almost as long as human civilization. Willow leaves were recorded on ancient Sumerian clay tablets as a treatment for arthritis. In 1500 B.C., the ancient Egyptian “Ebers’ Book of Ancient Medicine” recorded the use of willow bark and leaves on the body to relieve arthritis and back pain. Hippocrates, a famous ancient Greek physician who is regarded as the “father of medicine”, used to grind willow bark into powder for his patients to take. The analgesic Hippocrates found in the willow tree was salicylic acid, the prototype of aspirin, and wrote about it in his book. Although salicylic acid provided analgesia, it had side effects that were almost impossible to remove, damaging the stomach mucosa and causing stomach bleeding, leaving many patients with rheumatism under control but having to suffer from stomach problems. In the late 1800s, Felix Hoffman, the father of Felix Hoffman Sr., a chemist working in a pharmaceutical factory, used salicylic acid to get rid of the pain caused by arthritis, but vomiting and stomach discomfort also caused him pain. Perhaps overwhelmed by the immense pain his father was experiencing from the medication, Hoffman reviewed a series of papers and finally found a way to produce acetylsalicylic acid (ASA, the main ingredient in aspirin) that was stable and had fewer side effects. From then on, the history of rheumatic disease treatment was changed. On March 6, 1899, a patent application for the invention of aspirin was approved under trade patent number 36433. aspirin began to be produced at the Elberfurt plant in Wuppertal, Germany, and aspirin has been available ever since. Aspirin protects against heart disease Soon, aspirin was selling worldwide as an analgesic and had a global following of doctors who found a relationship between taking aspirin and the incidence of heart disease, although they weren’t sure. As a professor of epidemiology, Dr. Peter Elwood and his team at Cardiff University in England published a monograph in 1974 that conducted the first randomized trial of the relationship between aspirin use and mortality after myocardial infarction, which generated worldwide interest in the study of aspirin to reduce cardiovascular disease. In 1980, a summary analysis of the results of various trials on aspirin in heart disease prevention led to the convincing conclusion that aspirin could reduce the risk of heart attack by 25-30%. The reason aspirin can reduce the incidence of heart disease is that it inhibits certain properties of platelets that thin the blood, making our blood less sticky and preventing some of the cardiovascular diseases caused by embolism. In 1983, Dr. Charles Heinekens of Harvard Medical School began a study involving 22,071 healthy male physicians over the age of 40. 5 years later, the results of the study demonstrated that the half of the population taking aspirin had a 44% lower risk of myocardial infarction, a 66% lower incidence of first fatal myocardial infarction, and a 61% lower incidence of first fatal myocardial infarction in the diabetic population compared to the half taking placebo. The incidence of first fatal myocardial infarction was reduced by 66% in the diabetic population and 61% in the diabetic population. However, it was also found that those taking aspirin had a higher risk of cerebral hemorrhage than the control group. Several studies since then, while confirming that aspirin prevents the occurrence of cardiovascular disease, have also revealed that aspirin increases the probability of people having gastrointestinal bleeding, intracranial bleeding, and gastric mucosal injury. There is no objection to taking aspirin therapy for patients with a history of heart attack and stroke, as well as for patients with confirmed coronary heart disease. However, there has been controversy as to whether aspirin should be routinely taken in people who have no history of heart attack or cardiovascular event but are at risk for such events. Aspirin is a double-edged sword After more than 110 years, the word “aspirin” was frequently mentioned again at the World Congress of Cardiology held in China for the first time in June 2010, and there was a lot of controversy. However, there is a consensus among Chinese physicians on primary prevention of cardiovascular disease. In the second issue of the Chinese Journal of Internal Medicine in 2010, an article entitled “Chinese Physician Consensus on Primary Prevention of Cardiovascular Disease” was published by the Cardiovascular Medicine Branch of the Chinese Medical Association, authored by Hu Dayi, a well-known health education physician and chairman of the Cardiovascular Disease Branch of the Chinese Medical Association. The article lists 12 risk factors for cardiovascular disease including age, gender, race, family history, hypercholesterolemia, smoking, diabetes, hypertension, abdominal obesity, lack of exercise, lack of vegetables and fruits in the diet, and mental stress, and it establishes a method for assessing the risk of ischemic cardiovascular development in Chinese people. Since people with characteristics such as old age, diabetes and hypertension are both at high risk for thrombosis and bleeding, according to the assessment results, if the cardiovascular risk is greater than 8% in the next 10 years, the benefit of taking aspirin is greater than the risk; if the assessed risk is less than 6%, the risk is greater than the benefit. how can the 8% and 6% risk be assessed? This needs to be assessed by a specialist cardiologist. If you have more than three of the 12 risk factors for cardiovascular disease, please do not hesitate to go to the hospital immediately for an accurate assessment and use aspirin or other interventions scientifically and reasonably under the guidance of your doctor, and you may lament in a few years that you have made the right choice.