Thursday 13 January 2011

Aspirin: good for what doesn't ail you

Okay, I, like everybody else I imagine, know this little white pill as the tried and true method of dealing with a pounding head. However, over a number of years there have been reports of benefits to be had from this headache medication which go beyond just relieving the pain between our temples. Is this true or is this more of the urban legend which propagates so readily via the Internet gossip mill?

Heart Attack or Stroke
The Mayo Clinic, which I would classify as a reputable source of information, states in an article dated June 17, 2010:

Daily aspirin therapy may lower your risk of heart attack and stroke, but daily aspirin therapy isn't for everyone. Is it right for you?

You should consider daily aspirin therapy only if you've had a heart attack or stroke, or you have a high risk of either. And then, only take aspirin with your doctor's approval. Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding.

The same article goes on to explain how aspirin prevents heart attacks or stroke. Fatty deposits have already narrowed blood vessels. Aspirin reduces the clumping action of the platelets and the possibility of blood clots forming which would block the blood vessels. It is, however, strongly recommended that anybody talk with doctor about taking aspirin or any medication for that matter. Let's not forget that the old saying is "physician heal yourself", not "patient heal yourself".

As a FYI, "physician heal yourself" is a proverb from Luke 4:23 although I must laugh as the original saying supposedly means that one should take care one's own problems, not the problems of others and isn't necessarily referring to a doctor. But in taking care of our own problems, I will come back to the dangers of self-medication and the need to consult with your physician.

A December 2010 report on a study conducted by the University of Oxford in England, is shedding light on long-term benefits from low daily doses of aspirin. A dose of 75mg or about a quarter of a regular dose taken for longer than five years reduces deaths from bowel cancer by more than a third. It seems to reduce deaths from any cancer by 20% but noted that the benefits of aspirin only became apparent after taking the drug for 5 years or more, suggesting aspirin works by slowing or preventing the early stages of the disease so that the effect is only seen much later.

After 5 years of taking aspirin, the data from patients in the trials showed that death rates were 34% less for all cancers and as much as 54% less for gastrointestinal cancers, such as oesophagus, stomach, bowel, pancreas and liver cancers.

The study goes on to point reductions in the occurrence of various cancers, stomach, bowel, prostate, etc. but all of these happen over a period of 5, 10 or 15 years. In other words, the results are based on statistics and the results appear over a number of years, not immediately. This is indicating some sort of delayed preventative effect in that starting to take aspirin now doesn't immediately do something but only by taking it over years would any of us see something positive. And let's emphasise that these so called benefits are statistical. As the joke goes, if anybody lives long enough, they will eventually get cancer.

Professor Peter Rothwell of the Department of Clinical Neurology at Oxford University, who led the work, gave some explanations about the study and some cautions arising from it:

These results do not mean that all adults should immediately start taking aspirin, but they do demonstrate major new benefits that have not previously been factored into guideline recommendations. Previous guidelines have rightly cautioned that in healthy middle aged people the small risk of bleeding on aspirin partly offsets the benefit from prevention of strokes and heart attacks, but the reductions in deaths due to several common cancers will now alter this balance for many people.

I don’t think it’s necessarily right for the person who did the research to say what guidelines should be. We can’t say with absolute certainty that there won’t be some unknown harm in taking aspirin for 30 years, but it looks as if there would be pretty large benefits in reducing cancer deaths. People have to accept there’s some uncertainty here.

Final Word
The effect of aspirin in cases of heart attack and stroke has been documented for years. This new research shows more possible benefits to our health from this ubiquitous household remedy but cautions that more study will have to be conducted to better understand the relation between the drug and cancer.

Final final word: talk with your family doctor.

We all should be cautious about jumping off the deep end by starting to take aspirin on a daily basis. There is the warning that aspirin can cause bleeding in the stomach. Without knowing exactly what works and what doesn't work, let's not self-medicate. I recently talked about the benefits of vitamin D and it seems to be clearly documented that daily doses can be beneficial. Judging from this study from the University of Oxford, it would seem that aspirin may be taking a regular place in my medicine chest. But, I will talk with my family doctor!


Wikipedia: Aspirin

University of Oxford: Daily aspirin at low doses reduces cancer deaths - Dec 7/2010

University of Oxford - Oct 22/2010
Long-term effect of aspirin on colorectal cancer incidence and mortality

University of Oxford: An aspirin a day keeps colon cancer away - May 11/2007
These results do not mean that we should all start taking aspirin - the risk of bleeding with long-term treatment will offset benefit in people at low risk of colon cancer. However, the benefit will probably outweigh the risks in individuals known to be at high risk of bowel cancer, such as those with a strong family history or those who have had an adenoma in the past. Anybody who thinks that they might benefit should discuss the pros and cons with their family doctor.

BBC: Aspirin, cancer risk and a personal decision - Dec 7/2010
by Fergus Walsh, the BBC's medical correspondent
From now on I am going to take a daily low-dose aspirin. I intend to continue doing this for the next 25 years. It's a decision which every middle-aged person in Britain is going to have to consider in the light of research suggesting that aspirin significantly cuts the death rate from many common cancers.

BBC: Small daily aspirin dose 'cuts cancer risk' - Dec 6/2010
by Fergus Walsh, the BBC's medical correspondent
The benefit in cancer reduction were found from a low daily dose of 75mg... the annual risk of major internal bleeding was about 1 in 1,000 and aspirin roughly doubled that risk... the danger of major bleeding was "very low" in middle age but increased dramatically after 75.

YouDocs: The little pill that battles cancer, and could win - January 10, 2011


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