Aspirin Regimen Risks May Outweigh Benefits

Aspirin Regimen Risks May Outweigh Benefits

by Posted on: February 20, 2013Categories: LiveWell 24/7   

It sounds like a simple prescription. And with the recent news that aspirin may help prevent a variety of cancers — in addition to heart attacks and strokes — it probably sounds like a good idea to many.

But hold on. Aspirin may be a cheap, century-old drug made from plants known for many centuries to have medicinal properties, including pain and fever relief. Yet in 2012, doctors are still figuring out how to best use it, and how to offer patients its benefits without exposing them to unacceptable risks.

Simple, it’s not. In fact, the conversation you have with your doctor about whether to take a daily low-dose aspirin can get pretty complicated, and often the answer is “no.”

Don’t mix aspirin and other medicines

Never start an aspirin regimen without consulting a doctor. And when you do, expect a review of your heart risks and the meds you already take, says Fred Ralston, an internist in Fayetteville, Tenn., and former president of the American College of Physicians.

Many drugs, including ibuprofen, blood thinners and certain antidepressants, can be risky to combine with aspirin because they also increase risk of bleeding. And if you think you are having a heart attack?

Even then, it’s best to call 911 and seek expert advice before popping an aspirin, says the American Heart Association. Symptoms might be from something other than a heart attack, including conditions that might be worsened by aspirin.

“Many times people don’t see aspirin as being a medication because it’s so widely available and it doesn’t require a prescription,” says Richard Becker, a cardiologist at Duke University and a spokesman for the American Heart Association. “But there are potential hazards.”

Benefit for stroke survivors

For most middle-aged and older adults, the decision depends on the answer to one question: Will aspirin lower your risk of heart attack and certain strokes more than it raises risk of serious bleeding?

Aspirin can do both, because it interferes with blood clotting. But the ratio of risk vs. reward varies from person to person.

The easiest calls are for people who have had heart attacks, clotting strokes, bypass surgery or blocked arteries. They should take daily aspirin “unless there’s a good reason not to,” such as a history of ulcers or aspirin allergy, says Steven Nissen, chairman of cardiovascular medicine at Cleveland Clinic and co-author of Heart 411: The Only Guide to Heart Health You’ll Ever Need.

An example of the potential benefit: Heart attack survivors were 26% less likely to have another attack when they took a daily aspirin in one research review published in 2008.

But for people without clear cardiovascular risks, benefits often are outweighed by bleeding risks, from nose bleeds to stomach ulcers and sometimes devastating hemorrhagic (bleeding) strokes, Becker says.

Studies suggest many people with relatively low heart risks are taking aspirin inappropriately, and risking those bleeding crises, Becker and Nissen agree.

The heart association and other groups still urge physicians to advise patients on a case-by-case basis, taking into account factors including blood pressure, cholesterol, diabetes, smoking and family history.

You can calculate your own risks, Nissen says, using something called the Framingham risk score, available on many websites. He doesn’t recommend aspirin for anyone with less than a 20% risk of a heart attack or other serious heart problem within 10 years. Others may suggest lower cutoffs.

Clearly, calculations would change if aspirin were proved to prevent a variety of cancers.

But cancer experts say they have not seen that proof, despite the publication in March of three studies suggesting a broad, long-lasting anti-cancer effect that might outweigh bleeding risk. In one study, people who took a daily aspirin for three years had a 25% lower risk of any type of cancer.


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