Aspirin: Old Standby is the New Wonder Drug
It's been said that aspirin is so powerful, if were just being introduced today, it might be available only as a prescription drug. But aspirin was introduced to the world in 1897, and the white tablets - touted for their pain-relieving, fever-reducing and anti-inflammatory properties - became readily available over the counter in 1900. A century later, aspirin is still one of the most popular remedies around the world, and nearly every month, it seems, the public reads about the discovery of new benefits for this familiar old drug.
Many physicians now advise their patients to take an aspirin every day - not for relief of pain, fever or inflammation - but to forestall cardiovascular problems. Is aspirin really the right remedy for everyone?
"For those at risk for coronary heart disease, yes, unless it irritates their stomachs or there is some other contraindication," says David Gutterman, MD, Northwestern Mutual Professor of Medicine at the Medical College of Wisconsin and a specialist in internal medicine and cardiovascular disease.
"For patients with known coronary heart disease or for those at risk for cardiovascular problems, I recommend a low-dose (81 mg) aspirin every day. They may not need it every day," he says, "but it's easier to remember if it becomes a daily habit." To prevent gastric upsets, he often suggests they take an enteric, or coated, tablet.
For Adults Only
Low-dose aspirin is commonly referred to as children's or baby aspirin, although aspirin generally should not be taken by anyone under 18, Dr. Gutterman says, due to the risk of Reye's syndrome (R. Studies have shown that using aspirin or similar medications to treat viral illnesses like colds and flu increases the risk of developing RS, especially for children. RS affects all organs of the body but is most harmful to the brain and the liver - causing a sudden increase of pressure within the brain and, often, massive accumulations of fat in the liver and other organs.
Cardiovascular disease and the risk for it are especially prevalent among older residents of North America and Europe. To understand why daily aspirin is so widely recommended to prevent cardiovascular problems, consider how the disease develops: When coronary arteries that supply oxygen-rich blood to the heart muscle become narrowed or clogged by cholesterol and fat deposits, the result is coronary heart disease. When the blockage - called atherosclerosis - ruptures or breaks, exposing the underlying blood vessel tissue, the body reacts as if the vessel was cut and begins to generate a clot. This is what causes a heart attack.
Because aspirin slows the blood's clotting ability, regular usage helps to lower the risk of a heart attack. It also helps keep arteries open in people who have had a previous heart bypass or other artery-opening procedure such as coronary angioplasty. For the same reason, aspirin can be helpful in preventing stroke by reducing the risk of ischemia, which occurs when a blood clot decreases the flow of oxygen-rich blood to the brain.
Risks of Aspirin and Other NSAIDs
Aspirin is not without risks, Dr. Gutterman says. "Anytime you thin the blood by reducing its ability to clot, you increase the chance of bleeding, particularly in the digestive tract or brain." In part because of that risk, aspirin is currently not approved by the Food and Drug Administration (FDA) for preventing heart attacks in healthy individuals.
The National Heart, Lung and Blood Institute says: "Patients must be assessed carefully to make sure the benefits of taking aspirin outweigh the risks. It may be harmful for some persons, especially those with no risk of heart disease. Talk to your doctor about whether taking aspirin is right for you."
"We recommend very few drugs, if any, to all men and women," Dr. Gutterman says. "It's always a complicated question, and aspirin certainly has side effects. In addition to causing gastric or cerebral bleeding in some people, aspirin can sometimes have adverse effects in people with liver and kidney disease. But, on balance, among well-chosen, at-risk patients, it's a sound choice."
His view is supported by a study involving 55,580 men and women reported in the September 2003 issue of the Archives of Internal Medicine. It found that aspirin use was associated with a 32% reduction in the risk of a first heart attack and a 15% reduction in the risk of all-important vascular events. It concluded that "for apparently healthy individuals whose 10-year risk of a first coronary event is 10% or greater, the benefits of long-term aspirin therapy are likely to outweigh any risks."
Another study, reported in the same publication in January 2004, stated that "more widespread and appropriate combined use of statins and aspirin in secondary prevention of cardiovascular disease will avoid large numbers of premature deaths." Statins are drugs that reduce cholesterol.
In January 2004, the FDA warned consumers against overdosing on over-the-counter pain remedies, especially acetaminophen, including the Tylenol brand as well as generic tablets sometimes labeled "non-aspirin." Patients who take more than the amount of acetaminophen recommended on the label run the risk of liver damage, the FDA said, noting that about 56,000 people are treated in emergency rooms for acetaminophen overdose annually, and approximately 100 die from the effects. Acetaminophen is found in more than 600 products for colds, flu, coughs and pain.
The FDA also warned of overdosing on NSAIDS - non-steroidal anti-inflammatory drugs like aspirin, ibuprofen (such as Motrin), naproxen (such as Aleve) or ketoprofen (brand names include Orudis and Oruvail), citing their risk of such side effects as stomach bleeding and kidney problems.
Recent news stories have described aspirin's possible role in preventing other health conditions, but results so far have not been compelling.
Prostate Cancer: A study presented in January this year at an American Association for Cancer Research meeting found that aspirin "may modestly reduce the risk that a man will develop prostate cancer."
Hodgkin's Disease: In February, a study from Harvard University said regular aspirin use might lower the risk of Hodgkin's disease, but it added that more research is needed.
Alzheimer's Disease: Evidence is emerging that daily usage of NSAIDS such as aspirin or ibuprofen might help reduce the risk of Alzheimer's disease, based on several theories about the cause of the ailment. Since 1985, scientists at the Medical College of Wisconsin have been studying medications, including aspirin and ibuprofen, for their role in slowing the degeneration of cognitive abilities. "Studies here and at other institutions are continuing," Dr. Gutterman says. "It's still a bit premature for definitive conclusions."
Breast Cancer: The large national study called the Women's Health Initiative reported in 2003 that weekly use of ibuprofen and aspirin seemed to inhibit the formation and growth of breast cancer, according to data published in the Proceedings for the 94th Annual Meeting of the American Association for Cancer Research. One of the scientists involved in the study cautioned that before usage guidelines can be implemented, however, "additional studies are needed." A study reported in the May 26, 2004, Journal of the American Medical Association had similar findings, with the study authors agreeing that further research was needed before doctors recommend that women routinely take aspirin to prevent breast cancer.
"Aspirin can reduce estrogenic effects," Dr. Gutterman says, "similar to drugs like Tamoxifen." The female hormone estrogen influences certain types of breast tumors, and drugs that reduce the hormone's effects may be prescribed to patients who have had breast cancer to prevent a recurrence.
Intestinal polyps: Two studies published in the New England Journal of Medicine in 2003 looked at whether aspirin can prevent colon tumors, but the results were not considered great enough to warrant risking the sometimes deadly side effects of internal bleeding and stroke. "Although aspirin may be of some benefit in preventing colorectal cancer, it cannot yet be recommended for this indication and is not a substitute for screening and surveillance," one of the researchers wrote.
Meantime, the major health risk facing middle-aged and older Americans remains heart disease, and aspirin is known to be effective in helping prevent it, Dr. Gutterman says. "Since more of us will die of heart disease than any other condition, I'd say go where the money is, and reduce your risk with a daily low-dose aspirin. Check with your doctor first though.
"But," he adds, "aspirin's not worth a hill of beans if you take aspirin thinking that alone will protect you. Take the aspirin, and if you smoke, stop, because smoking puts you at the highest risk for heart disease." Other ways to reduce your risk - even if you already have coronary heart disease or have had a previous heart attack - are the old stand-bys: Aim for a healthy weight, be physically active each day, and if you have high blood pressure, high blood cholesterol or diabetes, make sure they're under control.
HealthLink Contributing Writer
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