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An open bottle of aspirin

The last time I rifled through the cluttered shelves in our hall closet desperately seeking a bottle of aspirin, I was suffering from an excruciating headache most likely caused by a harried day of air travel. That was two years ago, and I still recall pretty vividly that the remedy was not quite equal to the task.

I’ve been blessedly free of headaches since that evening, which means I’ve had no occasion to consider aspirin’s various strengths and weaknesses — a topic that seems to be of some interest to a large portion of my geezer cohort. For the past 30 years or so, we’ve been told that taking a low-dose aspirin every day could help prevent a heart attack or stroke. And though subsequent research has amended that recommendation to include only those who are at risk of cardiovascular disease, millions of heart-healthy seniors continue to dutifully pop those pills.

And that’s a bit frightening, says University of Georgia epidemiologist Mark Ebell, MD, because the hazards far outweigh the benefits. “We shouldn’t just assume that everyone will benefit from low-dose aspirin,” he explains in a statement. “And, in fact, the data show that the potential benefits are similar to the potential harms for most people who have not had a cardiovascular event and are taking it to try to prevent a first heart attack or stroke.”

Ebell and his team of researchers last week published a study in the journal Family Practice that quantified those dangers. Comparing data from aspirin studies that took place between 1978 and 2002 with research that occurred after 2005, they found that, for every thousand patients treated with aspirin over a five-year period, the earlier treatment protocol resulted in four fewer heart attacks or strokes than in the post-2005 period — but also seven more major hemorrhages.

“About one in 300 persons who took aspirin for five years experienced a brain bleed,” Ebell says. “That’s pretty serious harm. This type of bleeding can be fatal. It can be disabling, certainly. One in 300 is not something that the typical doctor is going to be able to pick up on in their practice. That’s why we need these big studies to understand small but important increases in risk.”

And, he added, the rise of statins and other drugs to control cholesterol and blood pressure since 2005 has made that daily aspirin regimen almost superfluous.

Before you shed a tear for Bayer and other purveyors of the traditional headache remedy, however, remember that there will always be scientists on the prowl for new reasons to prescribe old medicines. So, I wasn’t particularly surprised last week to also stumble upon a study in JAMA promoting aspirin’s ability to prevent certain cancers.

A team led by Holli Loomans-Kropp, PhD, MPH, a fellow at the National Cancer Institute, found that older persons who popped three or more aspirins each week were less likely to die from cancer than folks like me, who only use it every few years when struck by a debilitating airline-induced headache.

Those conclusions, Loomans-Kropp and her crew admitted, were clearly at odds with the earlier Aspirin in Reducing Events in the Elderly (ASPREE) study, which noted that regular aspirin usage among geezers increased the risk of mortality when compared with non-users. There was no mention of Ebell’s research, of course, since it was released on the same day.

I guess that’s one of the great things about medical research: You get to choose from a wide range of conflicting claims. Maybe an aspirin a day will keep cancer at bay, maybe it’ll prevent a stroke, maybe it’ll trigger a brain bleed.

It’s up to us to determine the risks and rewards. I don’t feel the need to pop an aspirin every day, for example, but it sure would be nice if it would do the job when a headache strikes.

Thoughts to share?

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