DOES AN ASPIRIN A DAY KEEP THE DOCTOR AWAY?
Many of us have a bottle of baby Aspirin kicking around in the back of the medicine cabinet, but until recently we haven’t had clear guidance about when to use it. We think of baby Aspirin as having preventive superpower — but what exactly does it prevent and who benefits most?
Aspirin hinders the formation of clots within the body, allowing major blood vessels to stay clear of obstructions and to carry blood to vital organs. The cost of this is an increased risk of bleeding, most often from the intestines but occasionally in the brain and other areas. Fortunately, this bleeding tends to be non-fatal and rare overall. Aspirin’s role in cancer prevention is less fully elaborated, but it appears to decrease the formation of prostaglandins, which are inflammatory compounds thought to stimulate tumour growth.
It’s well established that for people who have already had heart attacks and strokes, baby Aspirin works well to prevent future events. Guidance has been less concrete for those who have not yet had a heart attack or stroke, as the science has run the gamut, with many studies contradicting one another. Aspirin’s beneficial effects might reach beyond the cardiovascular system, as it could have a tangible effect on colon cancer prevention. But you need to take Aspirin for at least a decade if not longer to glean a colorectal cancer prevention benefit, making this an unfeasible proposition for all but the most committed.
Almost a dozen major studies have examined the use Aspirin in colorectal cancer and cardiovascular disease prevention, with more than 120,000 patients participating in the research. This spring the United States Preventive Services Task Force combined the data and published recommendations on the optimal way to proceed. In short, they recommend daily low-dose Aspirin for those aged 50-59 if they have at least a 10 per cent risk of heart attack or a stroke in the next decade. A number of online calculators can help determine your risk.
While in the 50 to 59 age range the benefits of Aspirin largely outweighed the risks, in the 60-69 group the benefits were more modest and again only applicable to those with a 10 per cent risk of heart attack or stroke in the next decade. For those aged less than 50 or greater than 70, all bets were off and the task force concluded they could not be confident enough in the science to make a recommendation in support of or against taking preventive Aspirin.
So what to do? Gone are the days of physicians doling out advice based on guidelines and textbook recommendations alone — this is a decision that needs to involve the patient and their preferences.
Some individuals may fear certain outcomes more than others, and those who fear bleeding complications or who are unlikely to comply with treatment might want to pass on preventive Aspirin.
However, motivated 50-59year-olds with a significant risk of cardiovascular disease who would be willing to take daily low dose Aspirin for 10 years and who fully understand the risks of bleeding can seal the deal with their doctors.