Aspirin revisited

Aspirin revisited

The good old aspirin … A real survivor, with extensive usage, from pain relief to preventative medicine.
Aspirin (acetylsalicylic acid) was first produced in tablet form in 1901, more than 100 years ago, and is now the most commonly used medication worldwide, with 40,000 tons being produced each year. As well as having analgesic and antipyretic properties, aspirin is known to reduce the risk of cardiovascular disease.
Even if people might think that they know everything about aspirin, my own clinical experience has proved that general knowledge is at a dangerously low level – “a little knowledge is sometimes worse than no knowledge”…
Most people have the idea that “an aspirin a day keeps the doctor away” and that the answer is, for everyone and everything, to take a baby aspirin per day.
“It ain’t necessarily so,” as the old song says.
Aspirin is undoubtedly a survivor. It is commonly taken for headaches, fever or arthritis pain, but in aspirin’s more recent history, many other uses were found and its use in disease prevention is established beyond doubt.
Today your doctor might prescribe a daily aspirin to prevent heart attacks, and in the future you might take aspirin to prevent some cancers and Alzheimer’s disease.
Aspirin’s naturally occurring precursor comes from the bark of willow trees and was used as a folk remedy for hundreds of years to relieve pain, lower fever and reduce inflammation, the same way we use modern day aspirin.
Aspirin, being a non-steroidal anti-inflammatory drug like ibuprofen, also reduces swelling, not like paracetamol that may relieve pain and control fever as well, but it is not an anti-inflammatory.
The Million Hearts Initiative, launched in 2011 by the US Department of Health and Human Services, aims to prevent one million MIs (heart attacks) and strokes over a five-year period by implementing what it describes as proven, effective and inexpensive interventions. In addition to blood pressure control, cholesterol management, and smoking cessation, the routine use of aspirin is recommended.
Patients with diabetes have a two to four times higher risk of cardiovascular events compared with people without the disease, and aspirin appears to produce a relevant reduction in MI and stroke in diabetic patients.

How does aspirin work?

Aspirin is used to prevent many circulation (cardiovascular) related conditions, as it interferes with the blood clotting, reducing the risk of blockages thus helping to maintain an efficient blood flow throughout the body.
This is why the main fear for the use of aspirin is related with the hemorrhagic risk of gastrointestinal bleeding and intracranial bleeding.

Aspirin and cancer

A relatively new area of research focuses on the role of prophylactic aspirin in reducing the risk of cancer, indicating that aspirin may prevent certain cancers, including colorectal, esophageal, breast, stomach and ovarian cancers. The evidence for the chemo preventative role of aspirin is strongest for colorectal cancer, the second most common cancer.
There is also growing evidence that aspirin has an effect on cancers already present, primarily in reducing distant metastases but also in increasing survival. Although several reviews have recommended the use of aspirin for cancer prevention, it is not clear just how much aspirin gives the most benefit.

The use of aspirin

Despite the body of evidence showing the effectiveness of low-dose aspirin in the prevention of CVEs (cardiovascular events) and the prevention and possible treatment of cancer and its inclusion in a variety of clinical guidelines, aspirin is underutilised in clinical practice.
Evidence on the cardiovascular benefits from aspirin, such as the almost 20% reduction in the risk of nonfatal MI, may be a persuasive argument in favour of aspirin.
When deciding whether to recommend the use of prophylactic aspirin for patients, the physician needs to balance the benefits from its use against its potential risks.
Many patients will have an overlapping risk for cardiovascular events and for cancer. For this reason, the cardiovascular and chemo-preventative benefits of aspirin use may justify the broadening of recommendations for its use in the primary-prevention arena, where it is currently underutilised. With this in mind, prophylactic aspirin use should be promoted within the context of the adoption of a healthy lifestyle rather than a substitute for it.
Our good old friend aspirin is a ‘lady’ of many resources, definitely a survivor, becoming more useful every day, more interesting, rejuvenated. The newly-discovered medicines are only being added to, not replacing, aspirin at the base of prevention guidelines for the number one killer of humankind, cardiovascular disease. But, as with everything else, please handle with care.
Talk to your doctor before you start taking aspirin regularly.
Best health wishes,
Maria Alice
By Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. Administrator/Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve