Aspirin – the wonder drug?

No longer regarded as just a headache cure, aspirin can reduce your risk of cancer, protect against strokes and heart disease and prevent miscarriage. So should we all be taking a daily dose?

Touted as the wonder drug of the 21st century, aspirin is credited with new health benefits on an almost daily basis. To date, scientists have found that it helps protect against heart disease and strokes, while also playing a part in reducing the risk of pre-eclampsia - a potentially fatal prenatal condition - and premature birth. And if that were not enough of an endorsement, it's also said to help fight breast, bowel, prostate and skin cancers, while proving an effective prevention against Parkinson's Disease. Yet opinions remain divided over the safety of ‘prevention prescribing' and whether the health benefits of regular doses of aspirin really do outweigh the risks.

 

Made from synthesised acetylsalicylic acid - a naturally occurring chemical that's derived from willow bark - aspirin was first patented in powder form by Bayer in 1899 and for 50 years was used purely as a painkiller. But no one actually understood how it worked until the 1970s, when it was found that aspirin prevents the enzyme cyclooxygenase from releasing prostaglandins, which transmit pain messages to the brain. Then, in 1953, a Californian GP noticed that not one of the 400 patients, for whom he had pre-scribed aspirin, had suffered a heart attack. This has since been shown to be due to aspirin's antiplatelet action which stops the formation of blood clots in the arteries, thus defining its huge potential in preventing heart attacks and strokes.

 

In 2005, after extensive research, Professor Peter Elwood of the University of Wales announced that everyone over the age of 50 should take a daily ‘mini' dose of aspirin (75mg tablets are available over the counter at pharmacies) to reduce the risk of a stroke or heart attack. He argued that the benefits far outweigh the side effects of indigestion and heartburn. However, his critics refuted this, citing more severe side effects, including irritation to the stomach lining, which can lead to ulcers and bleeding. The British Heart Foundation, therefore, currently advises that aspirin should only be taken when it has been established that the benefits clearly outweigh the risks. So, could aspirin help you? And what exactly are the risks?

 

Strokes

Every five minutes someone in Britain suffers a stroke and it's not just the elderly who are at risk - nearly a quarter of victims are under the age of 65. Studies have shown that aspirin can help prevent strokes, but if it's wrongly prescribed it can be very dangerous. Strokes occur when the blood flow to the brain is interrupted.

 

There are two main types: ischemic stroke, caused by a blood clot, and haemorrhagic stroke, caused by a broken or leaking blood vessel. Aspirin is beneficial for people at risk of an ischemic stroke, as it thins the blood, thus preventing clots. However, in the case of a haemorrhagic stroke, taking aspirin can actually stop the vital clotting mechanism from stemming the blood flow. The number of haemorrhagic strokes caused by blood-thinning drugs has increased seven-fold since the 1980s, according to a report from Oxford University. And researchers have warned that in healthy older adults, the risks of taking aspirin may well outweigh the benefits. Dr Peter Coleman of the Stroke Association says, ‘If you are healthy and have a low risk of heart disease or stroke, then the increased risks from the side effects of aspirin are likely to outweigh the benefits of preventing a stroke - so always consult your doctor before taking aspirin on a regular basis.'

 

Cancers

According to research by the Mayo Clinic in the US, taking aspirin regularly reduces your chances of developing cancer by 16 per cent, and if you do contract the disease while taking it, you are 13 per cent less likely to die from it as a result. It is thought that the drug reduces pre-cancerous growths, called adenomas, which can take about 10 years to develop into cancer. Studies conclude that it can reduce your risk of breast cancer by one  third; ovarian cancer by almost 40 per cent; prostate cancer by 20 per cent; bowel cancer by 37 per cent; the most common form of lung cancer by half; and squamous cell carcinoma - a form of skin cancer - by a huge 90 per cent.

 

The various studies, however, do not agree on the optimum dose - with some advocating a twice-weekly dose of ‘mini' aspirin (75mg) and others recommending you take it daily. ‘Regular use of aspirin really does seem to reduce the risk of a growing range of the most common serious cancers,' says Nick Henderson of the Aspirin Foundation. ‘But what dose of aspirin to use, how frequently to take it and even how it works are still unclear, but more work is being done to clarify these issues,' he adds.

 

Heart attacks

Aspirin is commonly prescribed to cut the chance of heart attacks, but research has shown that, for patients who are at low risk of a heart attack, it can do more harm than good. A study at the Royal Hallam-shire Hospital in Sheffield found that it can reduce the risk of a heart attack by almost a third, but it can increase the chance of bleeding complications by 70 per cent. ‘Anyone who thinks they are at risk of a heart attack should visit their doctor for an analysis of their possible heart attack factors,' says Professor Larry Ramsey, who led the study. He suggests that if your chance is moderately high, the benefits of a daily 75mg dose of aspirin would almost certainly outweigh the risks.

 

Parkinson's Disease

A recent study by Dr Angelika Wahner and the UCLA School of Public Health in Los Angeles found that women who were regular users of aspirin reduced their risk of Parkinson's by 40 per cent.

 

‘Our findings suggest that non-steroidal anti-inflammatory drugs (NSAIDs) are protective against Parkinson's Disease,' she says. ‘Aspirin was only shown to benefit women. This may be because men take lower doses for heart problems, while women may use higher doses for arthritis or headaches, aches and pains.' Parkinson's Disease involves the inflammation and degeneration of nerves, and it is thought that aspirin somehow prevents or protects from this. ‘It's possible that the drug's anti-inflammatory agent may contribute to the observed protective effect, but the exact mechanism isn't clear and further research is needed,' concludes Dr Wahner.

 

Pregnancy complications

According to a study conducted by Lelia Duley, professor of obstetric epidemi-ology at the University of Leeds and Dr Lisa Askie of the University of Sydney, which combined the results of 31 previous reports, women who took daily doses of aspirin between 75mg and 150mg (equivalent to between a quarter and half a tablet) were 10 per cent less likely to deliver their babies prematurely - before 34 weeks - than those who did not. The women were also 10 per cent less likely to develop pre-eclampsia - a potentially fatal condition characterised by high blood pressure and the presence of protein in the urine.

 

However, most doctors recommend that it is only women with an existing condition (whether that's a history of pre-eclampsia or recurrent miscarriage) who will benefit from taking aspirin - and should do so only on the advice of their GP. Angela Chalmers, consultant pharmacist at Boots, advises that a GP consultation is essential before aspirin is taken. ‘As a rule, as with any painkiller, aspirin should be avoided during pregnancy unless there is a very specific medical reason for taking it,' she says.

 

The same applies to women who want to use aspirin to promote conception. The drug can help women, who are prone to miscarriages, to conceive. Some GPs may prescribe a daily ‘mini' aspirin (75mg) to pregnant women in their first 12 weeks of pregnancy, when they're most vulnerable to miscarriage. As aspirin thins the blood, it can aid blood flow to the reproductive organs, uterus and foetus - so preventing foetal deprivation. But again, it is vital that it is only ever taken under the advice of your GP. 

 

Aspirin - The facts

• Aspirin should never be given to children as it is linked to the potentially fatal condition, Reye's syndrome.

• A common side effect is irritation of and/or bleeding from the lining of the stomach, which affects about three in every 1,000 people taking the drug.

• Stroke survivors who stop their daily dose treble their risk of a future stroke.

• Always take aspirin after eating food as its active ingredient, salicyclic acid, can irritate the stomach and lead to heartburn and indigestion and produce acid reflux.

• It may even cause a bleeding ulcer.

• Asthmatics should avoid aspirin because it can exacerbate the symptoms.

• Large doses have been found to cause temporary hearing loss and tinnitus.

• Anyone who is preparing for major surgery may be advised to stop taking aspirin for up to 14 days beforehand, as the blood-thinning effects can prevent essential blood clotting.

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