Aspirin Wonder Drug Essay
Follow me on Twitter @RobShmerling
Imagine that after years of painstaking research, scientists announced the development of a breakthrough treatment that costs pennies a pill, saves lives, and could reduce healthcare spending by nearly $700 billion in the coming years. And you wouldn’t even need a prescription to get it. Perhaps this all sounds too good to be true. But, according to a new study, we already have such a drug: it’s called aspirin.
An analysis of aspirin use
Based on current recommendations, only about 40% of people who should be taking aspirin are doing so. In this new report, researchers asked: what might happen to population health, longevity, and healthcare costs if aspirin use were more widespread? To answer this, they analyzed reams of health data from thousands of patients and estimated the impact of more widespread aspirin use on their health and survival.
Their findings were striking. For people in the U.S. ages 51 to 79, routine aspirin use could, over a 20-year period:
- prevent 11 cases of heart disease for every 1,000 persons
- prevent four cases of cancer for every 1,000 persons
- lengthen national life expectancy by about four months, allowing an extra 900,000 people to be alive in 2036
- save $692 billion.
Is there a downside to aspirin?
As is true for all medications, aspirin has its downsides. Among other side effects, allergic reactions may occur. And, aspirin is a blood thinner and can irritate the stomach. Episodes of bleeding and stomach ulcers can be serious. So, the researchers took these into account; the estimates above include these side effects of taking aspirin.
It’s important to emphasize that this study assessed the impact of low-dose aspirin, such as the 85 mg daily dose often found in baby aspirin; higher doses may be recommended for other conditions (and come with added risk). In addition, aspirin can interact with other medications. For example, if you take low-dose aspirin for your heart and ibuprofen for arthritis, it’s important that the ibuprofen be taken at least 30 minutes after or more than eight hours before the aspirin; otherwise, the benefit of the aspirin may be lost.
Who should take aspirin?
For those at highest risk of future cardiovascular problems, including those who have had a prior heart attack or stroke, aspirin is routinely recommended to reduce recurrence.
For everyone else, recommendations vary. Some experts recommend low-dose aspirin for everyone over age 50. Other guidelines make a more conservative recommendation based on age (e.g., 50–79 years old) and cardiovascular risk factors that predict a heart attack or stroke occurring in the next 10 years. Well-studied risk calculators, such as the one developed by the Framingham Heart Study, are available to estimate 10-year risk.
In addition, aspirin is routinely recommended to lower cancer risk in people with certain genetic conditions, including hereditary nonpolyposis colorectal cancer.
Why don’t more people take aspirin?
It’s not entirely clear why many people forego aspirin use. My guess is that it’s a combination of factors, including:
- a lack of awareness that aspirin is recommended
- it wasn’t specifically recommended by their doctor
- a greater concern about side effects from aspirin than its potential benefits
- a previous bad experience with aspirin use, such as an allergic reaction
- an aversion to medications in general.
It’s worth emphasizing that when it comes to any treatment — and especially preventive treatments — individual preferences matter a lot. As a result, many reasonable people who would be good candidates to benefit from aspirin will choose not to take it.
What does this mean for you?
For all the effort to identify new and better drugs, it’s remarkable that we aren’t taking full advantage of what we already have. This new study suggests that large health benefits are not being realized simply because not enough people are taking aspirin. But each person has his or her own set of circumstances that can affect the both the risks and the benefits of aspirin treatment, as well as his or her own preferences. The decision to take or forego aspirin is a big one — so add this to your list of things to discuss at your next appointment with your doctor.
A team of researchers led by Professor Peter Rothwell at Oxford University reviewed the data from eight separate trials on aspirin which together included 25,570 patients taking the drug regularly for on average four years.
They found that "all cause mortality" was reduced by 10 per cent for those taking a 75mg dose of the drug.
A normal over-the-counter pill contains 300mg.
For individual cancers the effect could be even stronger. The 20-year risk for prostate cancer was reduced by about 10 per cent, for lung cancer 30 per cent, bowel cancer 40 per cent and oesophageal or throat cancer by 60 per cent.
The study, published in the Lancet, suggests greater aspirin use could potentially save thousands of lives a year in relation to cancer alone.
Combined, all cancers claim more than 150,000 lives in Britain every year, while cardiovascular disease accounts for some 200,000 deaths.
Prof Rothwell, 46, who started taking aspirin two years ago, said it was likely to have a major impact on public health – and be even more effective than screening.
"The size of the effect of cancer is that it does more or less drown out those sort of risks," he said.
"I think it is not for me the person who has done the research to make recommendations but I suspect that the guidelines will be updated as a result of these findings.
"This is likely to be much more effective than screening.
"It looks as though as there is a pretty large benefit in terms of reducing cancer and the risks are really pretty low.
"It looks likely the longer you take aspirin, the greater the benefit."
Prof Rothwell believes that the sensible time to start taking aspirin would be in the early to mid 40s when the risk of cancers start to go up.
Prof Peter Elwood, of Cardiff University’s School of Medicine, conducted the first trial into the effect of aspirin on heart disease in the 1970s, started taking the drug about that time.
Now 80, he believes the risks are "trivial" compared with the benefits.
"It is very exciting evidence and should be investigated more fully," he said.
"It really is a remarkable drug."
It is just latest claim for aspirin which was formulated as a painkiller more than a century ago. It is now linked with helping in diseases ranging from heart disease to cancer to dementia.
Advocates believe that its active ingredient is akin to a vitamin that almost everybody should take, as our modern diet does not provide it.
It is thought that it works in cancer because it boosts the body's ability to root out, repair or kill rogue cells that can develop into cancer.
For heart disease it thins the blood and reduces the risk of clotting.
The researchers believe that the optimal time for taking the tablet would be between 45 and 75 years old – before which the risk of cancer is to low – and after which the risk of internal bleeding is too high.
If taken with milk at night it could be even more effective as calcium is thought to boost aspirin's effect and the active ingredient of the pill is more powerful during sleep.
They believe that it would be effective against breast and ovarian cancers but there were too few patients studied to get a definitive result.
"Perhaps the most important finding for the longer-term is the proof of principle that cancers can be prevented by simple compounds like aspirin and that 'chemoprevention' is therefore a realistic goal for future research with other compounds," said Prof Rothwell.
Prof Alastair Watson, Professor of Translational Medicine at the University of East Anglia, said the study was a very important development.
"It is further proof that aspirin is, by a long way, the most amazing drug in the world," he said.
Cancer Research UK described the study as "promising".
But the charity warned that patients should consult their GP before deciding to take aspirin daily because of the drug's side effects.
A spokesman for the National Institute for Health and Clinical Excellence (NICE) said it would take into account the new evidence when reviewing it guidelines.
"We do review and update all our guidance on a regular basis, and if there is new evidence that we think might change any of our existing recommendations, then we will take that into account, " he said.
A Department of Health spokesman said: "We welcome this addition to the evidence base and note that more research is required before clear conclusions can be drawn on the implications for clinical practice."