Will Aspirin Really Protect Me from Disease
Once it was just a ho-hum over-the-counter ache-and-pain remedy. But in less than a decade, aspirin has been transformed into a superstar drug, touted for its tantalizing promise of preventing heart attacks, fending off recurrent strokes, and possibly deterring digestive cancers. But before you rush to your medicine cabinet, you should realize that researchers still have a lot of questions about this powerful and potentially toxic "wonder" drug.
Can it help some people prevent the three big killers? Probably. Is it for everyone? Nobody knows yet. Most researchers are cautious, but some advocates say that the existing evidence is compelling enough for broad recommendations.
"The real controversy with aspirin has been whether someone who isn't at high risk for these diseases should take it. In my estimation the medical establishment has been a bit too conservative about aspirin," says Tim Byers, M.D., professor of preventive medicine at the University of Colorado School of Medicine in Denver. "The risks of low doses of aspirin are fairly minimal, and the benefits may be high. I know I'm going to start taking aspirin regularly when I reach age 50. I think it's a reasonable choice to make for most people who are 50 and above."
It's Not Just for Headaches Anymore
Ironically, when it was first developed 100 years ago, aspirin was rarely used because doctors feared that it would weaken the heart. Now many physicians and scientists consider it to be a simple, cheap deterrent to cardiovascular disease.
In the landmark Physicians' Health Study, for instance, 22,000 healthy male doctors up to age 84 took either a standard 325-milligram aspirin or a placebo every other day. (A placebo is a look-alike tablet that has no medical effects.) After five years, those who had been taking the aspirin instead of the placebo had a 44 percent lower risk of suffering a first heart attack.
When the results of 25 similar studies of people who had previous heart attacks and strokes were pooled together, researchers found that those who took aspirin regularly had a 32 percent lower rate of subsequent nonfatal heart attacks. They also had 27 percent fewer nonfatal strokes and had a 15 percent reduction in death from cardiovascular diseases.
"I think what we know for sure right now is that in healthy people aspirin will prevent a first heart attack," says Charles Hennekens, M.D., Dr.P.H., professor of medicine at Harvard Medical School. "If you've had a prior heart attack, stroke, or unstable angina—the kind that occurs even when you're not exerting yourself—we know conclusively that aspirin will prevent a recurrence of all of those events and lower the death rate."
But whether aspirin reduces the probability of a first stroke is still questionable because researchers simply don't have enough information yet, Dr. Hennekens says.
Researchers do know that aspirin protects the heart in a couple ways, says W. Steven Pray, R.Ph., Ph.D., professor of nonprescription products at Southwestern Oklahoma State University in Weatherford and a columnist for U.S. Pharmacist magazine. First, the drug prevents blood platelets from sticking together and forming blood clots. Second, it may suppress the secretion of chemicals in the blood that contribute to the formation of atherosclerosis, hardening of the arteries, Dr. Pray says.
If you are having a heart attack, taking a 325-milligram aspirin while you're waiting for the paramedics to arrive may reduce the severity of the attack and save your life, Dr. Hennekens says.
"The benefits of aspirin are enormous in that situation," Dr. Hennekens says. "If it's a heart attack, aspirin will reduce the death rate by 23 percent if it is taken within 24 hours of onset and continued daily for 30 days. That alone could save 10,000 lives in the United States a year."
Can an Aspirin a Day Keep Cancer Away?
Researchers also are excited about aspirin's potential to squelch digestive tumors.
In an analysis of 662,000 white men and women, American Cancer Society researchers found that those people who took aspirin 16 or more times a month for a year had 40 percent lower rates of esophageal, stomach, colon, and rectal cancer than those who didn't use the drug.
Harvard University researchers found a 37 percent reduction of colon cancer risk after 10 years of regular aspirin use among 90,000 nurses up to age 72. The most effective dose appeared to be four to six aspirin tablets a week. A similar Harvard study of 48,000 male health professionals up to age 75 found that men taking two or more aspirin a week had a lower risk of colon cancer by 32 percent.
Other studies have shown that at least in animals and in people with a rare genetic predisposition to polyps, aspirin helps block the formation of precancerous polyps in the colon, says Michael Thun, M.D., director of analytic epidemiology at the American Cancer Society in Atlanta.
How aspirin protects the digestive tract isn't clear. The drug may inhibit the production of prostaglandins, hormonelike substances that may cause cancer cells to grow more rapidly. Another possibility is that aspirin boosts the body's immune system so that the body is better able to fight off tumors.
More studies are needed, however, before researchers can endorse aspirin as a preventive measure for digestive cancers, Dr. Thun says.
"Basically, there are good reasons to think that aspirin may have some role in the prevention of colorectal cancer," Dr. Thun says. "The catch is that we haven't proven it." Because aspirin will help some people and harm others, it's difficult to recommend its broad, regular use in the general population, he says. In some people even one adult aspirin (325 milligrams) daily can cause stomach bleeding or strokes from bleeding. There is still no certainty that these risks are outweighed by the potential benefit, except in people at high risk of heart attacks or strokes from clotting.
But Dr. Byers believes that it is only a matter of time before aspirin becomes generally advised to stave off cancer and cardiovascular diseases.
"The only questions that really remain are what is the proper dose and how often should you take it," Dr. Byers says.
| Stick with the Right Dose Aspirin isn't kind if you overdo it. "Some medications you can get away with taking too much of, but aspirin isn't one of those," says W. Steven Pray, R.Ph., Ph.D., professor of nonprescription products at Southwestern Oklahoma State University in Weatherford and a columnist for U.S. Pharmacist magazine. Adverse reactions include kidney failure, hearing loss, ringing in the ears, vision difficulties, stomach irritation, gastrointestinal bleeding, confusion, dizziness, and headaches. Never exceed the dosage recommended by the manufacturer or your physician, Dr. Pray says. If you're taking the aspirin, avoid using other over-the-counter medications that contain the drug. These products can increase your risk of overdosing. Read the list of ingredients carefully. Look for words like aspirin, acetylsalicylic acid (aspirin's chemical name), or other salicylic acids like bismuth subsalicylate, which can interact with aspirin and cause many of same side effects, he says. Some common brand-name products to avoid if you're taking aspirin include Alka-Seltzer, Aspergum, BC Powder, Cope, Ecotrin, Goody's Headache Powders, Halfprin, Momentum, Stanback Powders, Vanquish, and Pepto-Bismol, Dr. Pray adds. Taking one of the pink antidiarrheal products can be particularly tricky, Dr. Pray says, because it's often not obvious from the label that they contain a salicylate. "So people who have upset stomachs, hangovers, or diarrhea may take one of them without realizing that it contains a salicylate. Then they'll take a couple of aspirin for their headaches. So they're actually doubling their dosage of salicylates. That sort of thing can be very troublesome," he says. |
Making It Work for You
Because researchers do suggest such a wide range of doses varying from 81 milligrams every other day (one chewable tablet) to 325 milligrams daily (one regular aspirin), consult your doctor before you begin taking aspirin routinely, Dr. Hennekens says. Your doctor will help you determine if taking the drug is a worthwhile step for you, and he can recommend a proper dosage.
Here are some other suggestions from medical experts.
Scope out your medicine cabinet. Check with your doctor or pharmacist before taking aspirin with any prescription or over-the-counter drugs, Dr. Pray says. Ibuprofen and other anti-inflammatory drugs, for instance, add to the adverse effects of aspirin.
Sit up. After age 60, it often becomes harder to swallow aspirin and other tablets. Stand or sit up when swallowing your aspirin. Take the drug with an 8-ounce glass of water at least an hour before bedtime or lying down, says Jacob Karsh, M.D., a rheumatologist and professor of medicine at the University of Ottawa in Ontario, Canada.
Munch on something. Aspirin is less likely to cause stomach pain, nausea, or other digestive upsets if you take it with food, Dr. Byers says. So have the drug with meals or during a snack.
Protect your stomach. Some aspirins are easier on your digestive tract because they have special coatings that allow them to pass through the stomach and digest in your small intestine, Dr. Byers says. Look for brands that are buffered or enteric-coated.
Go beyond aspirin. As promising as aspirin appears to be in preventing these diseases, it still needs your help, Dr. Hennekens says. Lifestyle changes such as low-fat eating, getting regular exercise, and not smoking can have more impact than any drug on your risk of disease.
| Aspirin Allergy: Rare, but Potentially Lethal Like all drugs, aspirin isn't for everyone. About 3 of every 1,000 people develop allergic reactions to aspirin. By age 60 most people who are allergic to aspirin know it because they have had at least one adverse reaction. But the allergy can develop at any age. "It's like a bee sting. At any time, your body can develop an allergic reaction to aspirin even if you have never had a problem in the past," says W. Steven Pray, R.Ph., Ph.D., professor of nonprescription products at Southwestern Oklahoma State University in Weatherford and a columnist for U.S. Pharmacist magazine. "Many people develop hives or rashes, but it can be life-threatening. If you're allergic to aspirin, your airways can shut down so that you can't breathe." People over 60 who have asthma should be particularly cautious about aspirin use, since they are 10 times more prone to serious allergic reactions than those who don't have asthma, Dr. Pray says. If you have hay fever, you are 5 times more likely to be aspirin-sensitive. If you take aspirin and develop hives or a rash, stop using the drug and see an allergist or your family doctor as soon as possible. Seek emergency medical attention immediately if someone has difficulty breathing after taking aspirin, Dr. Pray says. |
Prescription for Prevention
While doctors remain reluctant to recommend that all of us use aspirin on a daily basis, a growing stack of evidence suggests that this reliable drug may be more than just a remedy for muscle soreness and headaches. When used in combination with other healthy habits such as exercise and low-fat eating, aspirin may be a powerful preventive action against stroke, heart disease, and cancer for people over age 60.
Do:
* Check with your doctor before taking aspirin on a regular basis.
* Take coated aspirin with food to protect your stomach.
* Take your aspirin with 8 ounces of water at least an hour before bedtime or before you lie down for a nap.
Don't:
* Take aspirin without checking about your other medications. Some prescription medications like Percodan and over-the-counter drugs like Alka-Seltzer contain aspirin (also called acetylsalicylic acid) or other salicylic acids like bismuth subsalicylate. If you're already taking aspirin, the additional aspirin in these products can cause adverse reactions like kidney failure or stomach upset. So read product labels carefully and check with your doctor.
