Study Questions Preventive Use of Aspirin

Aspirin is cheap, widely available and demonstrably good at relieving pain. In recent decades, some people have been advised to take it to lower their risk of heart disease and stroke, although, as our blog last year noted, they might want to reconsider the habit of using aspirin as a preventive measure for cardiovascular disease. A new study confirms that caution, as well as for its prophylactic (protective) effect on cancer.

The research, conducted in the U.K. and published in the journal PloS One, found that older adults who took aspirin saw only a small decrease in their risk of heart problems, but that taking the drug regularly could increase significantly their risk of suffering a stroke or bleeding problems.

Their meta-analysis – a broad review of 27 trials, including randomized, controlled studies considered the scientific gold-standard – showed small “absolute” effects of aspirin on cardiovascular disease and cancer (particularly colorectal cancer), but that use “for primary prevention of CVD the absolute harms exceed the benefits.”

“Unwanted or harmful effects such as bleeding and stomach pain can also result from taking aspirin,” the researchers wrote. “It is particularly important to know the risk of harmful effects when considering an intervention for primary prevention since by definition it will be used by a population people who are well and free from CVD or cancer.”

Because cancer and cardiovascular disease are huge, global concerns, using aspirin as a primary prevention measure for either, or both, could have a huge, global impact that’s counterproductive. And dangerous.

The researchers also point out that international guidelines for preventive aspirin use differ, and that no guidelines currently recommend routine use of aspirin for adults. American Heart Association guidelines recommend aspirin for patients at “high risk” of cardiovascular events.

And the U.S. National Cancer Institute, they report, continues to conduct research to determine the role of aspirin as a preventive measure. The U.S. Preventive Services Task Force (USPSTF) recommends against the routine use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer in individuals at average risk.

Aspirin use, according to the meta-analysis, probably prevented the deaths of 33 to 46 people in 10,000 over a 10-year period. But during that period and among the same 10,000 study subjects, 46 to 49 experienced major bleeding and 68 to 117 had gastrointestinal bleeding.

They concluded that the risk of stomach bleeding increased by more than one-third, as did the risk of stroke.

So before you decide take aspirin as a preventive measure, discuss it with your doctor. And be mindful, per our blog, that taking aspirin along with other NSAIDS (ibuprofen, acetaminophen, etc.) invites additional risks of bleeding.

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