An Aspirin a Day ... or Not?
Aspirin's protective powers may now guard against cancer, too.
Studies reviewed by the U.S. Preventive Services Task Force
have shown that daily or every-other-day aspirin therapy reduced the risk of
coronary heart disease by 28%in persons who had never had a heart attack or
stroke, but who were considered high-risk individuals.
It's also pretty easy to identify those individuals who, in all
probability, don't need to take aspirin on a daily basis, Fendrick says.
Healthy people in their 20s and 30s, for example, with no cardiac risk factors
and no major risk factors for developing the other diseases aspirin can
prevent, such as certain cancers, should consider the risks of aspirin therapy
to outweigh the benefits.
But then there's a large group of people that fall into the
middle category -- the "probably-should-take" group. For these people,
individuals with a strong family history of colon cancer, for example, or
dementia, balancing aspirin's potential benefits against its well-documented
risks can be a very complicated equation. "The benefits of aspirin for
preventing colon cancer, dementia, and heart attacks need to be carefully
weighed by a medical professional against the potential for serious
complications," says Dr. Fendrick.
The FDA also provides a fact sheet on deciding whether or not
daily aspirin therapy is right for you (it's specific to heart disease) on its
More Isn't Always Better
If you and your doctor decide you should be taking aspirin
daily, the next question is, "How much?" In the land of the super-size,
is it any wonder that we think that if one pill is good, two must be better,
and if 100 milligrams may help prevent cancer, 200 or 300 milligrams must have
twice or three times as much cancer-busting power? Stop right there.
Medications don't work that way, and especially in the case of aspirin and
other NSAIDs, a little goes a long way.
"Low-dose aspirin, a 'baby aspirin' dose of 81 milligrams,
is safer and just as effective as the standard adult dose of 325
milligrams," says Dr. Fendrick. "When a drug has serious side effects,
as aspirin does, you want to give the lowest effective dose. We know now that
you don't need 325 milligrams in a great majority of circumstances."
A patient who's having a heart attack right now, for
example, should be given a full 325-milligram dose of aspirin, but the person
at elevated risk for a heart attack, who's taking daily aspirin as a preventive
measure, should stick with the smaller 81-milligram dose.
Taking low-dose aspirin isn't the only way to maximize the
drug's benefits while minimizing its dangers. For people at increased risk of
gastrointestinal complications, Fendrick recommends combining any aspirin
therapy with a prescribed proton pump inhibitor (PPI) such as Prevacid,
Prilosec, or Nexium.
In a study of people with prior gastrointestinal bleeding,
whose doctors felt their chance of having a heart attack was high enough to
warrant aspirin therapy despite its gastrointestinal risks, a standard dose of
Prevacid reduced their risk of further bleeding by about eightfold.
Enteric-coated aspirin or buffered aspirin do not appear to have a reduced risk
of bleeding or other adverse events in the stomach.