Alexander C. Chester, MD

Recently the New York Times ran an op-ed entitled “The 2,000-Year-Old Wonder Drug” extolling the benefits of aspirin for a number of illnesses including cardiovascular disease and cancer. Although quite enthused about aspirin as a disease preventive, the author does advise medical consultation about the risks versus the benefits.

Is aspirin usually a good idea for middle-aged American? For those with known cardiovascular disease it usually is. However, one year ago a large study in the Archives of Internal Medicine did not show a reduction in cardiovascular or cancer deaths in patients without prior cardiovascular disease taking low-dose aspirin. A reduction in non-fatal heart attacks was noted. This benefit, however, was associated with a 30% increased risk of significant bleeding. The authors conclude against the routine use of aspirin for patients at low risk for cardiovascular disease.

More concerning, than the well-known risk of bleeding from the stomach or intestines, is the possibility of bleeding in the brain. Although the absolute risk of intracranial vessel bleeding is small (two hemorrhagic strokes per 10,000 patients taking aspirin) the consequences can be devastating.

Also, does aspirin prevent cancer? The evidence suggests that it is effective in preventing colon cancer and might be effective in preventing other cancers, although the evidence for the latter is less clear. The dose necessary to produce a statistically significant reduction in colon cancer is not certain, but some suggest that a full aspirin (325 mg) rather than low-dose aspirin (81 mg) might be needed.

The increased risk of bleeding associated with any dose of aspirin, and the possibility of greater risk with a higher dose, along with the very useful colon cancer prevention strategy of colonoscopy now in place caused the American Cancer Society not to recommend the routine use of daily aspirin to prevent colon cancer.

Patients at low risk for cardiovascular disease should consult their doctor before committing to a lifetime of daily low-dose aspirin. Low risk is defined as a patient whose 10-year absolute risk of a first coronary disease event is less than 10%. The doctor can calculate the risk by using a formula derived from the Framingham study of cardiovascular disease.

Aspirin is the wonder drug touted in the New York Times but, as usual in medical matters, every situation is different.

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