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Health Benefits a Matter of Risk Vs. Risk
Dr. David Lipschitz
first developed as a painkiller almost a century ago, is still viewed
by many as a miracle drug. While rarely prescribed for pain, aspirin’s
major use is its effect on platelets.
Aspirin prevents the formation in platelets of a molecule called thromboxane
A2 that is essential for normal platelet aggregation. Platelets play a central
role in stopping bleeding by first attaching to a bleeding wound, then aggregating
together to form a plug. Coagulated plasma and red cells combine with the platelet
plug to form a blood clot.
While essential to stop bleeding, platelets can cause harm by aggregating in
a blood vessel damaged by the deposition of cholesterol. This leads to a clot
that either partially or completely blocks a blood vessel. This can occur in
many areas of the body but is most serious when a coronary or cerebral artery
is blocked, leading to a heart attack or stroke.
Studies in recent years indicate that taking as little as a baby aspirin (81
milligram) daily can interfere with platelet function sufficiently to prevent
platelets from aggregating and reduce the risk of heart attack or stroke.
Aspirin has other benefits, according to a study published in the journal Lancet.
The study tracked more than 25,000 subjects taking aspirin for at least 20 years.
The research suggested that aspirin decreases the risk of lung cancer by 30 percent,
colon cancer by 40 percent and esophageal cancer by as much as 60 percent. The
National Cancer Institute reports that aspirin may protect against breast and
prostate cancer. Most experts believe that by inhibiting certain enzymes, aspirin
decreases inflammation that in turn reduces the chance of cells transforming
and becoming cancerous.
Based on these observations, many health-care providers recommend that all adults
take an 81-milligram aspirin daily in the hope of preventing heart attacks, strokes
and cancer. Using a medication to prevent an illness in otherwise healthy and
asymptomatic individuals is referred to as primary prevention.
To be effective, there must be a proven benefit that outweighs any potential
side effects. Good examples of primary prevention are the addition of fluoride
to water to reduce the risk of tooth decay and cavities as well as the fortification
of flour and cereals with iron to reduce the risk of anemia due to iron deficiency.
Thanks to these preventive public-health approaches, tooth decay and iron deficiency
have become quite rare. And in these two examples, the adverse effects are insignificant
enough to make the approach valuable.
But is primary prevention of using aspirin worthwhile? First, it must significantly
lower the risk of disease, and second, it should have virtually no risk. Unfortunately,
research just published in the Archives of Internal Medicine showed that aspirin
does not reduce the risk of death from heart attack, stroke or cancer in otherwise
In this study, more than 100,000 healthy subjects with no risk factors of vascular
disease were divided into two groups, either receiving aspirin or a placebo.
After a follow-up period of six years, there were 1,500 nonfatal and 500 fatal
heart attacks and an equal number of fatal and nonfatal strokes. The only benefit
of aspirin was a 10 percent reduction in the number of nonfatal heart attacks.
Particularly worrisome was a 31 percent increase in the risk of life-threatening
bleeding from the stomach.
Now experts are saying that healthy people should not take aspirin, as the side
effects lead to more problems than they prevent. Its use in the prevention of
cancer is now also in question.
This does not mean that aspirin should no longer be prescribed for anyone. The
information is watertight that aspirin prevents second heart attacks and strokes.
Aspirin should also be used in people at high risk of disease, including anybody
over the age of 60, smokers and those with diabetes, high blood pressure, elevated
cholesterol or proven evidence of vascular disease. Using aspirin to prevent
illness in such people is referred to as secondary prevention and its use in
those with disease and illness is referred to as tertiary prevention.
Always consult your physician before starting or stopping any treatment including
aspirin. Be aware of the risk factors of heart disease and stroke and if needed,
aspirin still remains a valuable and effective medication in high-risk individuals.
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