Written by Dr Farooq Rahman for Doctify

Aspirin was originally used to treat pain, fever and inflammation. Nowadays it is more commonly taken by people who have heart disease to help prevent a heart attack. Research also suggests it can be taken by healthy people to prevent heart disease and bowel cancer, but the risk of side effects can outweigh the potential benefits for many.
Aspirin is classed as an NSAID (non-steroidal anti-inflammatory drug – the painkillers ibuprofen and diclofenac are also NSAIDS). Aspirin works by inhibiting two enzymes  – biological machines that help facilitate biological processes, such as the formation of important chemicals with the body. By blocking these enzymes, aspirin limits inflammation, and so reduces pain and blood vessel damage.
It has been suggested for a while that taking a low-dose of aspirin every day (less than 100 mg/day) can have beneficial long-term effects such as:

  • Reduced risk of heart disease in patients aged 50-59
  • Reduced risk of developing certain cancers, such as bowel cancer (this benefit requires patients to have taken daily aspirin for 5-10 years)
  • Although it is a generally well tolerated drug, aspirin is know to have several side effects including:
  • Stomach and duodenal ulcers, which can cause pain and bleeding. It is estimated that 1 in 500 people who take aspirin may suffer with a large bleed each year
  • Tinnitus (ringing in the ears)
  • Skin rash and allergy (this is unusual)
  • Increased risk of stroke caused by bleeding
  • The risk of aspirin-related bleeding is low in adults aged under 60 and is moderate in adults aged 60-69

Is there a correct dose of aspirin?

A number of studies have shown that prevention of heart disease and cancer only need a very low dose of aspirin – less than 100 mg each day. People who take more than this have a higher risk of side effects without achieving significant extra benefits.
A recent study published in the Annals of Internal Medicine investigated which patient groups would benefit most from taking a daily dose of aspirin. They considered factors such as estimated life-expectancy, risk of developing heart disease, benefits of taking the medication and risks of taking the medication. Below are a summary of the findings:

 

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Patients aged 50-59 years old

If patients have:
– a 10% chance, or higher, of developing heart disease within 10 years; AND
– they are not at an increased risk of bleeding as a result of taking the aspirin; AND
– they have a life-expectancy of at least 10 more years;
then taking a low dose of aspirin on a daily basis for 10 years is recommended to reduce the risk of developing heart disease or colorectal cancer. This is because the benefits of taking daily aspirin outweigh the risks by a moderate amount.

Patients aged 60-69 years old

If patients have:
– a 10% chance, or higher, of developing heart disease within 10 years; AND
– they have a life-expectancy of at least 10 more years;
then they should consider a low dose of aspirin on a daily basis to reduce the risk of developing heart disease or colorectal cancer. However, the benefits of taking aspirin only outweigh the bleeding risk by a small amount.

 

Patients younger than 50 or older than 70

Unfortunately, the study did not find sufficient evidence to support the self-administration of daily aspirin in these patient groups.

What should I do?

If you are already taking aspirin, the risks can be significantly reduced by taking stomach protection agents such as proton pump inhibitor medicines. This is particularly important for people whose endoscopy tests have already shown that they have stomach ulcers or other risk factors for bleeding.
If you want to start taking a daily aspirin to prevent heart disease or cancer, please speak to a doctor before doing so. As it can have serious side effects in certain patient groups, it is important to ensure you receive the go-ahead from a medical expert.

 

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