ASPIRIN’S HIDDEN COST

TwenTy years ago, aspirin was the new great hope for heart problems: not only was it a painkiller, but it could also thin your blood (by reducing the clumping of blood platelets) and reduce your risk of cancer, including bowel cancer.

Indeed, it continues to be the first-line treatment for those who have had a heart attack or stroke to prevent further blood clots, and a preventative treatment for those at increased risk of such an event.

THE CONCERNS

IT HAs long been known that aspirin can damage the protective mucus lining of the stomach, allowing ulcers to form, and cause pre- existing ulcers to bleed, so it has fallen from favour as a painkiller.

But a new trial published in October in the new england Journal of Medicine has now challenged the idea that low- dose aspirin may prevent heart attacks or strokes in healthy older people.

The study of 19,000 people aged over 70 showed low-dose aspirin (100mg) taken daily does not significantly reduce the risk of a first heart attack or stroke, or improve disability-free survival (defined as being free of dementia or physical disability).

Furthermore, it showed an increase in the number of cases of serious bleeding among the aspirin-takers (3.8 per cent) compared with those taking a placebo pill (2.8 per cent).

‘Millions of healthy older people may be taking low-dose aspirin unnecessarily,’ the lead investigator, Professor John Mcneil, of Monash University, commented.

WHAT IT MEANS FOR YOU

AsPIrIn is still thought to benefit those who have already had a heart attack, stroke or angina, says Professor Peter rothwell, director of the Centre for Prevention of stroke and Dementia at the University of Oxford. ‘ There is also evidence that aspirin reduces the risk of heart attacks, strokes and cancer in people in their 50s and 60s who have not had a heart attack or stroke, but the benefits are relatively small.

‘The new study, however, cautions against healthy individuals starting aspirin after the age of 70,’ says Professor rothwell.

‘The benefits for cancer prevention might be larger in people with a family history of colorectal cancer, or who have had a bowel polyp or cancer, but the exact balance of risk and benefit isn’t known.

‘If you’re on aspirin, don’t stop taking it, but discuss the risks with your GP.’

sultan Dajani, a community pharmacist from eastleigh, Hampshire, says older people have a thinner stomach lining, making them more vulnerable to the bleeding aspirin can cause. But ‘ these risks can be reduced by taking your tablets with food and taking a PPI’, he says. THESE cholesterol-lowering drugs, which include atorvastatin and simvastatin, are prescribed to at least seven million people in the UK to lower levels of ‘bad’ cholesterol and reduce the risk of heart attack or stroke.

In 2014, the National Institute for Health and Care Excellence (NICE) recommended that everyone with a 10 per cent or higher risk of having a heart attack or stroke in the next ten years should be prescribed 20mg a day; those with established heart disease should start on 80mg a day.

In practice, this means almost all men over 60 and all women over 75 qualify for statins prescriptions — in total, 11.8 million people, according to U.S. research published in the Journal of British General Practice in 2017.

And it’s not just older people. More than a third of 30 to 84-year-olds exceeded the thresholds, 9.8 million of them healthy and with no history of heart attacks or strokes, the same study found. THE CONCERNS SOME GPs are concerned about ‘medicalising’ so many people, especially when some complain of side-effects such as muscle pain and mental fogginess (although many experts claim side-effects are rare).

A review of 300 trials carried out since 1990 and published in The Lancet in 2016 concluded that prescribing statins to people who hadn’t previously had a heart attack or stroke prevented 80,000 heart attacks and strokes a year in the UK, and that the benefits far outweighed any harm from side-effects.

However, critics such as Dr Malcom Kendrick, a GP in Cumbria and author of A Statin Nation: Damaging Millions In A