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Should We Take a Daily Aspirin or Not?

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For decades now, we hear of taking aspirin daily as a way to prevent heart disease. Some of my patients even take it upon themselves to start taking a daily baby aspirin because they think it is a healthy thing to do.

I would like to start first by saying that everyone should always clear this with their doctor first before doing it, and if you have already started, make sure that you let your doctor know that you are taking it on a regular basis as soon as you can.

The reason I am saying this is not because of the recent studies about aspirin... although we'll get to that in a minute. The reason I am saying this is because I want everyone to get into a habit of always keeping your doctors updated on all of your medications or supplements, because you never know when it might become an important thing that your doctors need to know about, when your health is in a less than optimal situation.

Having said that, let's get back to the topic of taking a daily aspirin...

In recent months, there has been some conflicting information in the news about aspirin -- whether it prevents cancer or whether it doesn't, and whether it actually puts people at higher risk of bleeding unnecessarily or not. Let's take a moment and try to get some important take-away points from these review studies so that we can safely use the information to our health benefit.

Let's start with the discussions that started in January of 2012, when studies suggested that using aspirin for heart disease or cancer prevention in otherwise healthy individuals unnecessarily puts these people at higher risk for bleeding. The concern was -- and is -- that aspirin, when used for disease prevention, may unnecessarily be putting people at risk for bleeding. However, aspirin is seen to be beneficial for those with strong history concerning for heart or vascular disease or cancers. So, should aspirin be used for prevention or not, and does it actually put people at higher risk for bleeding unnecessarily?

Then, in more recent months, some review studies looked at prior studies and concluded that daily aspirin therapy has a significant benefit for prevention of cancers, including colorectal cancer and esophageal cancer -- not to mention the cardio-protective effects of aspirin on top of that. These studies suggest that the bleeding risk is mitigated with long-term low-dosage daily use and becomes less of an issue with regular long-term use in the appropriate individuals and that bleeding from daily low-dose aspirin therapy is not a major consistent concern for most people.

So, what are we, as the general public, supposed to think? Do we or do we not use aspirin on a daily basis for heart disease and cancer prevention? Should we or should we not worry about the increased risk of bleeding?

As you may have noticed, the phrase that keeps repeating in these news reports is the concept of "in the appropriate individuals." This is the key concept I want you to take away with you from these reports... that baby aspirin is still medicine and that daily use should be something that you decide on whether it is appropriate or not for you with your physician.

The reason is because depending on your risk factors and your other medications, daily baby aspirin may in fact be beneficial for some; while for others, it would be inappropriate. You should also keep in mind that just because baby aspirin was at one point in your life appropriate for you, it may not always be appropriate if you have new diseases or conditions, or are on new medications. So you should always double check about your medications with your physician at your yearly physical to make sure that the medications you are on are still appropriate for your medical status.

While more studies may be needed to further decide whether daily aspirin therapy is indeed appropriate for all healthy individuals for heart disease prevention and cancer prevention, there is a distinct possibility that these studies will never be done at a large enough scale to definitively quiet the naysayers, because aspirin is a relatively inexpensive generic drug and may not be able to generate the glitz and glamour of a larger-scale study in the future to give us skeptics the definitive answer.

However, there is enough data thus far to give us a clear idea of what to do in the following examples:

  1. If you have a strong family history of cancers, especially gastrointestinal cancers, and you are not on any medications that put you at higher risk for bleeding and you have no history of bleeding disorders, you may be a good candidate for daily baby aspirin therapy; therefore you should have that discussion with your doctor.
  2. If you have a bleeding history or you are on medications that already impede your platelet or clotting ability and you are at higher risk for bleeding, you need to speak with your doctor first before placing yourself on another medication that might make you bleed more. In this case, you may not be a good candidate for daily aspirin therapy, especially if you do not have a strong family history of heart disease or cancers.
  3. If you have a strong family history of heart disease, you are also potentially a good candidate for daily aspirin therapy... However, if you are already on a medication that helps with preventing clot formation, you need to speak with your doctor about taking additional aspirin therapy.

As you can see, the potential multitude of clinical scenario permutations are vast and these are only three examples of potential clinical scenarios in which individuals would be making that decision as to whether to take a daily aspirin; so you should always check with your physician first before making the decision to take or not take a daily aspirin.

In real life, the clinical scenarios are usually much more complicated and warrant a more in-depth discussion with your doctors. That's why you should always clear the usage of daily aspirin therapy with your treating physicians to ensure maximum safety for yourself.

After all, you have the doctors you have enlisted to be a part of your health care team for a reason... Why not utilize their expertise in this all-too-important decision? Even if it is just a baby aspirin in your mind, just remember that it is still a medication and thus should still be treated with caution.

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Reference:

[1] Rothwell PR, et al "Short-term effects of daily aspirin on cancer incidence, mortalilty, and nonvascular death: Analysis of the time course of risks and benefits in 51 randomized controlled trials" Lancet 2012; DOI: 10.1016/S01450-6736(11)61720-0. Rothwell PM, et al. Lancet 2012; DOI: 10.1016/S0140-6736(12)60209-8.

[2] Rothwell PM, et al "Effect of daily aspirin on risk of cancer metastasis: A study of incident cancers during randomized controlled trials" Lancet 2012; DOI: 10.1016/S0140-6736(12)60209-8.

[3] Rothwell PM, et al "Effects of regular aspirin on long-term cancer incidence and metastasis: A systematic comparison of evidence from observational studies versus randomized trials" Lancet Oncol 2012; DOI: 10.1016/S1470-2045(12)70112-2.

[4] Seshasai SRK, et al. "Effect of Aspirin on Vascular and Non-vascular Outcomes: Meta-Analysis of Randomized Controlled Trials." Arch Intern Med. 2012;172(3):209-216. doi:10.1001/archinternmed.2011.628

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