An Aspirin a Day or Not?
There’s little doubt that one of the most controversial drugs available today is the low-dose aspirin tablet. Touted for years as a magic pill to prevent heart attacks, new research has highlighted the dangers of daily aspirin use in those who don’t already have cardiovascular disease (CVD). So our family practice doctors in Delray Beach would like to help you sort out the confusion surrounding this common drug.
A study published last month in the Journal of the American Medical Association (JAMA) found that people without heart trouble who took a daily dose of aspirin (81 milligrams) had a lower risk of heart attack, stroke, and death. These benefits, however, were canceled out by the increased risk of bleeding in the intestinal tract or the brain.
“This calls into question the net benefit of taking aspirin, and whether people who have not previously had cardiovascular disease should take aspirin,” Dr. Sean Zheng, lead author of the study and academic clinical fellow in cardiology at King’s College Hospital in London, told CNN.
Researchers performed a meta-analysis of 13 studies that included 164,225 participants, none of whom had CVD when the studies began.
“For every 256 patients treated with aspirin for five years, one heart attack, stroke or death from cardiovascular disease would be prevented,” Zheng told CNN. “On the other hand, for every 210 patients treated with an aspirin over the same period, one would have a serious bleeding event.”
Dr. John McNeil, a professor in the Department of Epidemiology and Preventive Medicine at Monash University’s School of Public Health and Preventive Medicine in Australia went even further, saying his own study (ASPREE, or Aspirin in Reducing Events in the Elderly) showed that aspirin failed to provide any benefit at all to those over the age of 70. He called his results “quite unequivocal.”
But another study in 2016 by a medical team out of the University of Southern California (USC) provided evidence that a low-dose (81 mg.) aspirin tablet a day not only found a significant benefit with daily aspirin use, but a 30 percent reduced risk of cancer and a 17 percent reduced risk of stroke.
According to this study, 81 mg. of aspirin daily reduces the death rate from heart disease by 22 percent. This result was most pronounced in people aged 50 and over. The study recommended that adults ages 50 to 59 who have a cardiovascular risk above 10 percent, with a life expectancy greater than 10 years, should take a low-dose aspirin every day, assuming they aren’t at increased risk for bleeding.
Other studies have indicated a reduced risk of breast cancer, colorectal and intestinal cancers, liver, ovarian, prostate, head and neck cancers, and melanoma, as well as Alzheimer’s disease, through the daily use of low-dose aspirin. Others have shown that taking a low-dose aspirin during high-risk pregnancies may help prevent premature labor. In women who have previously miscarried, aspirin has proven to increase the chances of carrying a pregnancy to term by 20 percent, as well as to increase the chances of conception by 17 percent.
As with any drug, it’s important to weigh the risks and benefits. With all these possible benefits, it might seem sensible for everyone to simply down an 81-mg. aspirin tablet every day, but the very real risk of internal bleeding is a serious complication.
Dr. Mark Fendrick, a professor of Internal Medicine at University of Michigan School of Medicine, told The Guardian that aspirin is one of the first drugs he would pack to take on a desert island. But he also cautions that the side effect of gastrointestinal bleeding is a leading cause of deaths each year.
Taking aspirin regularly decreases the level of stomach protection and increases a propensity to bleed, as well as doubling the likelihood of a perforated ulcer. Researchers have found no difference in plain aspirin or enteric-coated when it comes to the risk of internal bleeding.
In the ASPREE trial, among those who took a daily aspirin, 361 suffered a significant bleeding event requiring hospitalization or a blood transfusion. Those who were taking a placebo had about 100 fewer bleeding events.
As researchers continue to evaluate the risks and benefits of aspirin, we would caution you to treat aspirin as you would any powerful drug. Just because it’s often called “baby aspirin” and is available over the counter doesn’t mean it comes without serious risks.
If you want to add aspirin to your health regimen, please check with us first. We can tell you the dose and frequency that will yield the greatest benefits with the fewest side effects.