Doctor In Your House: Aspirin: help or hindrance?
BY EVAN L. LIPKIS, MD Special Columnist
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Aspirin comes was discovered in 1850 and is derived from the bark of Willow trees. Let’s navigate a few important studies together so we can understand why aspirin may be useful to you. This drug is perhaps the most powerful drug known to man. It has so many effects (good and bad), that it would likely never get through the current FDA approval process.
Can aspirin reduce heart attacks and strokes?
The simple answer is yes. Aspirin will greatly help a middle aged male smoker who has high blood pressure, diabetes and high cholesterol versus the same man who has no cardiac risk factors whatsoever.
In general, low-dose aspirin is recommended for men age 45 to 79 and women age 55 to 79. These are the ages where the risk of bleeding is usually offset by aspirin’s cardiovascular benefits. Interestingly, the benefits are different for men and women. For men, the benefit is to prevent a heart attack. For women, the benefit is to prevent a stroke. The more risk factors, the greater the benefit.
What are the main side effects?
Even a baby aspirin can cause silent ulcers and gastrointestinal bleeding. You may not have any pain and the stool may turn black. Increasing age and previous intestinal bleeding are risk factors for having bleeding from aspirin. Proton pump inhibitors such as omeprazole or Prilosec can reduce the chances of such bleeding by over 90 percent. Rarely, regular use of aspirin is associated with a small but statistically significant increase in the risk for neovascular age-related macular degeneration (AMD). This is the leading cause of blindness in the USA.
Can aspirin prevent cancer?
Many studies show that when aspirin is taken daily, mortality is reduced for many solid tumors such as breast, colon, lung and prostate. Melanomas may be reduced in postmenopausal, Caucasian women. This drug can also reduce the spread or metastasis of cancer. Aspirin can cause intestinal and intracranial bleeds so these risks need to be discussed with your physician before beginning a daily aspirin regimen.
Does aspirin have any other positive benefits?
After having a blood clot, a daily aspirin can reduce future blood clots by 30 percent. Blood clots contribute to one out of every five deaths. Aspirin helps with arthritis complaints and reduces the rates of heart attacks. Other anti-inflammatories increase the incidence of heart attacks. Depression is likely an inflammatory condition of the brain. Aspirin may help to reduce this ailment in older men with elevated homocysteine levels. Homocysteine is a risk factor for heart disease and can be measured by a blood test.
What is the appropriate dose to take?
In almost all circumstances, low dose aspirin (81mg) is preferred. Such a low dose can reduce intestinal bleeds by 50 percent. During a heart attack, a full aspirin (325 mg) is recommended and can be swallowed or chewed.
Take aspirin with food and with a full glass of water. Enteric-coated tablets are more costly and no safer than a standard aspirin tablet. Taking an aspirin at night does not help reduce heart disease any better than a morning dose.
Doctor’s Summary: Aspirin can reduce heart disease and strokes in higher risk individuals. It may reduce cancers and recurrent blood clots as well. Be cautious if you have any bleeding disorder or acute macular degeneration. Consult with your doctor before beginning a daily aspirin regimen.
Dr. Evan Lipkis, MD, is a physician, author and lecturer based in Glenview, Illinois. The advice contained in this column is for informational purposes only. Readers should consult with their physician to evaluate any illness or medical condition. Contact Dr. Lipkis through his web site at: www.drlipkis.com