Vinod Kurup

Hospitalist/programmer in search of the meaning of life

Aspirin for Everyone

Aspirin is one of those wonder drugs - simple, cheap and effective versus so many deadly diseases. We know that aspirin prevents heart attacks and strokes, especially if you’ve had one before. There is also some data that it prevents colon cancers, but it was thought that this effect was only seen when using high doses of aspirin. The downside of aspirin is that it increases your risk of bleeding, especially gastrointestinal bleeding (usually from stomach ulcers). Using high doses of aspirin tends to increase the bleeding risk so much that it offsets any benefits.

When someone has had a stroke or heart attack, using aspirin is a no-brainer (secondary prevention). The question is when to start aspirin in patients who have never had a bad event (primary prevention). We used to be much more liberal about recommending aspirin for primary prevention, but there haven’t been many studies which have supported the practice. The current guidelines state to consider starting aspirin for primary prevention in men at age 45 and women at age 55, if their risk of vascular disease outweighs their risk of gastrointestinal bleeding. That’s a wishy-washy way of saying “Leave it up to your gut.” (No pun intended)

I decided to write about this because I saw a recent study showing decreased deaths from cancer in aspirin users, even at low doses. Overall cancer rates were 20% lower and gastrointestinal cancer rates were 35% lower than in people who didn’t use aspirin. These data come from 2 meta-analyses of retrospective studies, which tend to be a relatively weak type of study. Prospective studies are much better, but these numbers strike me as significant.

Given this new data, I would strongly favor using aspirin in most people once they hit those age cutoffs (45 & 55), which for me is pretty soon. Calculate your cardiovascular risk. If your risk is any more than 10% or so, I would recommend taking an aspirin daily, possibly even if it’s lower. The reasons that I would recommend not taking an aspirin are if you have frequent stomach ulcers, previous severe bleeding, or if you’re taking blood thinners or high doses of NSAIDs (ibuprofen, naproxen). Here’s a nice fact sheet that summarizes what I’ve just rambled about (Wish I had seen that before I wrote all this!)

Disclaimer: Don’t take medical advice from the internet. Show this to your doctor so they can tell you what a quack I am.

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