ANN ARBOR, MI - There seems to be a lot of new attention focused on good ole' fashioned aspirin, so much so that it's recently been touted as a 'wonder drug.' Evidence is rapidly growing that supports aspirin's use in lowering the rates of heart attack, stroke, colon cancer and even Alzheimer's disease. Given its widespread benefits and extremely low cost, the question is raised, "is daily aspirin therapy for everyone?"

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"Although taking aspirin leads to a wealth of potential health benefits for adults, people should realize that even a baby aspirin is not free of dangerous side effects," says A. Mark Fendrick, M.D., an internist at the U-M Health System. "Therefore, in my opinion, aspirin should not be taken on a daily basis without first discussing it with your health care provider.

According to Fendrick, aspirin use should be based on the tradeoff between the risk of disease you are trying to prevent, such as a heart attack, and the risk of side effects, such as a bleeding ulcer. "Most consumers are not aware of this tradeoff," he says.

Aspirin falls into a drug class called non-steroidal anti-inflammatory drugs or NSAIDs. It's one of the most carefully studied drugs available and has been used to reduce pain and inflammation for over a century. Aspirin's action as a blood thinner saves a large number of deaths from heart disease each year.

"I think aspirin is currently undergoing a bit of an identity crisis," says Fendrick. "Because it's been around so long and is available over the counter for pennies a day, many people can't believe that aspirin is equally or more effective than prescription drugs that cost over a hundred times more."

Living up to its reputation as a 'wonder drug', aspirin has been shown in clinical studies to reduce the rate of heart attacks, strokes and related deaths. The ability of aspirin to prevent blood from clotting (makes the cells 'less sticky') prevents these events from happening. Aspirin also helps even if a heart attack or stroke does occur and often reduces the severity of the event.

"The benefits of aspirin go beyond the cardiovascular system. There is solid evidence that aspirin slows the progression of colon cancer, and some preliminary data suggests that regular aspirin use may prevent certain cancers from occurring at all," says Fendrick. "Also population-based studies report that an aspirin a day will either slow the progression or even prevent dementia, such as Alzheimer's disease," he continues.

"It appears that most people will get these benefits with very tiny doses - only 81 milligrams a day or one baby aspirin," says Fendrick.

Since the risk of side effects goes up with the dose of aspirin, Fendrick recommends that most people who are using regular doses (325mg) switch to low-dose aspirin.

"Aspirin is not benign," says Fendrick. "Thousands of people die each year in the United States from complications related to taking aspirin and other NSAIDs.

"When you take aspirin, the level of stomach protection is decreased and you're more likely to bleed. Thus, people who take aspirin regularly - even in a buffered or coated form - will have roughly double the likelihood of having a perforated ulcer or bleeding in the GI tract," explains Fendrick.

"Relatively little attention is paid to this problem that kills more people in the U.S. each year than asthma or cervical cancer," he continues. The risk of stomach bleeding is increased substantially if aspirin is combined with other NSAIDs (both over-the-counter and prescription strength). These include the newer COX-2 selective NSAIDs, such as VIOXX and Celebrex that in the absence of aspirin are safer on the stomach.

"Ask your clinician if low-dose aspirin is right for you," says Fendrick. "While aspirin is potentially a life saver in many instances and we want to encourage its use, there are also many people taking this drug who don't realize that the risks of bleeding may greatly outweigh the health benefits gained."

Fendrick categorizes his patients into three groups. The 'must have' group is well-defined and is limited to individuals with a documented personal or family history of heart disease, such as coronary artery or vascular disease, or those with risk factors for heart disease such as diabetes, high blood pressure or high cholesterol.

The 'probably should take' group is more complicated, says Fendrick. "The benefits of aspirin for preventing colon cancer, dementia and heart attacks need to be carefully weighed by a medical professional against the potential for serious complications," he says.

Fendrick says individuals who shouldn't take aspirin on a daily basis include those with very low risk of developing the diseases aspirin is used to prevent. "For these people, such as your typical twenty-something reader of health magazines, the well-documented risks of aspirin overcome any health benefits that may be achieved," he says.

Facts about aspirin:

• Aspirin is acetylsalicylic acid and falls into a class called non-steroidal anti-inflammatory drugs or NSAIDs.
  
• Due to aspirin's blood thinning effect it can reduce coronary heart disease events and stroke.
  
• Research indicates that aspirin will slow the progression of cancer and may prevent it in the G-I tract.
  
• Research suggests that taking an aspirin a day will either slow the progression of, or even prevent, dementia.
  
• Aspirin has side effects including a reduction in stomach protection. When taking aspirin people double their likelihood of having a clinically meaningful bad event such as an ulcer.

Find more information on the World Wide Web at:

American Heart Association: Aspirin in heart attack and stroke prevention
www.americanheart.org

American Cancer Society: Baby aspirin may reduce risk of colon cancer
www.cancer.org

Alzheimer's Association: Fact Sheet: Anti-inflammatory Therapy
www.alz.org

Written by Maria White

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