Aspirin: the preventative that wasn’t

dushazmi

People over 50 are supposed to start taking one-a-day aspirin to
prevent heart disease—but the evidence suggests any benefits
are far outweighed by its dangers For most doctors, preventative
medicine means giving patients
drugs. The drugs may be different
from the ones they’d prescribe when
the patient gets sick, but they’re drugs
nonetheless. And sitting at the very apex
of preventative drugs is aspirin, with
doctors telling patients over the age of
50 that they should start taking 75 mg a
day to prevent heart disease and stroke.
More recently, they’ve added colorectal
(bowel) cancer to the list.
And it does seem to be doctors—and
patients who are self-medicating—who
are driving this and even going against
the advice of health agencies. For one,
the US Food and Drug Administration
(FDA) has stated that it “does not believe
the evidence supports the general use of
aspirin for primary prevention of a heart
attack or stroke.”
One survey highlighting the problem
found that almost half of respondents
with no history of heart disease were
taking aspirin, which is contrary to the
recommendations of agencies such as
the FDA. And the strongest predictor
of taking aspirin—whether correctly
or incorrectly—was having discussed it
with their doctor.1
But then doctors are getting mixed
messages. Thousands of headlinegrabbing
medical trials (around 3,500
are published every year) have claimed
that aspirin is a lifesaver—both against
heart disease and stroke, and now
colorectal cancer—while groups such
as the American Heart Association
support the use of low-dose aspirin to
protect against heart disease, especially
in women under 65; the UK’s National
Health Service (NHS) website also
recommends low-dose aspirin as a
preventative drug.
And what’s not to like about aspirin?
Used as a painkiller, fever reducer and
anti-inflammatory for the better part
of a century, it’s seen as a benign remedy
that we’ve taken for years for aches and
pains, and now to prevent heart disease.
As a result, we pop around 100 billion
aspirin pills every year worldwide, many
taken by healthy people who agree with
their doctor that aspirin is, indeed, the
ultimate just-in-case remedy.
The statistics seem to back up the
claim that it’s a safe drug. The American
Association of Poison Control Centers
reports an average of 59 deaths from
aspirin a year, while researchers have
estimated that just 7,600 people die
each year from complications of
taking an NSAID (nonsteroidal antiinflammatory
drug) painkiller, whether
it’s aspirin, ibuprofen or naproxen.2
Yet, even in the early days when
aspirin was first being promoted as a
heart disease preventative, there were
those who questioned its benefits and
safety. Lately, those voices have reached
a crescendo. They warn that aspirin isn’t
as effective as claimed, and it’s not so
benign either.
Not for those over 70
Researchers from Monash University in
Australia think that any healthy person
over the age of 70 should stop taking
aspirin. Once you reach that age—and
provided you don’t have any heart
problems—the risks of taking aspirin
start outweighing the benefits. In fact,
that threshold could be reached as early as
age 45, say the researchers, who looked at
the effects of aspirin on a group of 19,114
healthy people, half of whom were taking
100 grams of aspirin a day and the rest
a placebo, or dummy pill. For a healthy
45-year-old, the way to prevent heart
disease is through diet and exercise, not
by turning to aspirin.
When the researchers analyzed the
two groups—those taking an aspirin a
day and those taking a placebo—they
discovered that there was no difference
in the number of heart disease cases
after seven years. However, the rate of
life-threatening hemorrhages, including
bleeding in the stomach and brain, was
much higher in the aspirin group.3
Researchers from Brigham and
Women’s Hospital in Boston came to
a similar conclusion when they took a
look at the effects of aspirin on a group
of people who were at moderate risk of
having a first heart attack, based on their
high blood pressure or cholesterol levels.
Half of the 12,546 people in the study
were taking aspirin, and the rest—with a
similar risk profile—were instead given
a placebo.
In the five years of the study, heart
attack rates were similar in both groups;
in other words, aspirin wasn’t protective.
Yet many more in the aspirin group also
suffered gastrointestinal (GI) bleeding.4
GI blues
Although GI bleeding is a recognized
side-effect of taking aspirin, the risk is far
greater than many believe, and it becomes
life-threatening by the time you reach the
age of 75. By then, your risk of a major
stomach bleed is four times greater than
in younger age groups.
Among people under 65 taking
aspirin, the rate of fatal or lifethreatening
bleeds was less than 0.5
percent, or one person out of every 200.