Tag: heart disease

Recently, I saw a 36 year old man in my office with bowel problems. His first question was: Doc, should I take an aspirin a day to prevent colon cancer?

First, let us look back in history.

Hippocrates and the Indians of North America have known the pain killing properties of willow bark, which contains salicylates (aspirin is acetylsalicylic acid), for many hundred years.

Besides it being a painkiller, it also reduces inflammation and fever. Commercially, aspirin became available in 1899 as a result of a search by Felix Hoffman at Bayer Industries to help his father who suffered from rheumatoid arthritis.

By the 1960s, aspirin became the most widely used pharmaceutical product in the world. For example, in U. S. alone, the annual production of aspirin is over 15,000 tons (13,600 metric tons).

In 1985, researchers first established that aspirin can prevent heart attacks. If you have chest pain and are suffering a heart attack, then taking an aspirin will reduce your chance of dying from heart attack by 25 per cent. It also reduces the risk of a second heart attack by 50 per cent. For patients who have suffered a stroke, it offers protection from a second one.

So, what about cancer prevention?

For the last 25 years, researchers have been saying that aspirin, ibuprofen and other anti-inflammatory drugs may play a role in preventing cancer. Studies have found that it could reduce the risk of both colorectal cancer and mouth and throat cancers by two-thirds.

In one recent study, women who took a single ibuprofen tablet at least three days a week for 10years or more saw their risk of breast cancer fall by 49 per cent.

Women who regularly took aspirin saw their risk of breast cancer drop by only 28 per cent.

There is also some evidence that ibuprofen may offer more protection from Alzheimer’s disease. Canadian researchers have shown that ibuprofen may reduce the risk of getting Alzheimer’s by up to 30 per cent.

If this is all true then why physicians do not promote the use of aspirin and ibuprofen as a prophylactic for cancer prevention?

The above findings are from retrospective studies – they look back at men or women who were taking these products for other illnesses and see if they suffered from specific cancers compared to those who did not take aspirins or ibuprofens.

There are no prospective randomized double blind trials to prove that aspirin or ibuprofen is what prevents cancer. There may be other variables which may influence the outcome. Prospective randomized double blind trials eliminate those variables.

Many doctors are cautious about the idea of healthy people taking aspirin or ibuprofen in the hope of preventing disease. More studies are needed to confirm that the benefits outweigh the risks. They don’t know what dose is appropriate, or how many years the drugs must be taken before they offer protection.

These drugs are not always harmless. Internal bleeding is a serious risk. The painkillers can also interact dangerously with other drugs.

Recently, the Globe and Mail wrote, “Randall Harris, a respected professor of epidemiology at Ohio State University, didn’t follow the cautious approach when he announced the results of the breast-cancer study. Instead of recommending waiting until more studies are done, he urged women over the age of 40 to talk to their doctors about taking a standard dose of ibuprofen (200 milligrams) or aspirin (325 mg) daily.”

But there are other reports which say that taking ibuprofen may undo the protective effect of aspirin.

Are you confused? So are the doctors! But my answer to the young man is – there are many other ways of preventing cancer (remember ELMOSS?) – rather than looking for a miracle drug.

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“Approximately 25 percent of the reduction in the rate of death from coronary artery disease that has occurred during the past 30 years may be explained by the practice of primary prevention,” says Dr. Michael Lauer, of Cleveland Clinic Foundation, in an article in the New England Journal of Medicine (NEJM).

What is primary prevention?

Primary prevention involves a deliberate treatment of a person with established risk factors for heart disease although the person has no clinical symptoms or other evidence of heart disease. The purpose is to prevent cardiac events like heart attack.

What are the risk factors for heart disease which can be target of primary prevention?

There are several of them: high blood pressure, smoking, high cholesterol level, sedentary (much sitting and little exercise) life style, platelet activity (a type of blood cell which can stick together and block coronary arteries) and inflammation.

Family history of heart disease is a risk factor as well but there is not much you can do to change that!

What is the role of aspirin in primary prevention?

Aspirin has both anti-platelet and anti-inflammatory effects. In 1970s, studies suggested regular aspirin use could reduce the risk of heart attack and death from coronary artery disease, says the NEJM article. More recent studies have confirmed this although many aspects of aspirin use are uncertain.

The article’s conclusions are:

-Aspirin use probably reduces the risk of heart attack in men over the age 50 years. It is unclear whether women have the same sort of benefit as men.
-The decision to initiate aspirin therapy should be based on assessment of absolute risk of a heart attack.
-For prevention of heart attack, low doses of aspirin (100 mg per day or less) are adequate. For prevention of stroke, low-dose aspirin is just as effective as high-dose therapy.
-Observational studies have suggested that aspirin may prevent cancer of the colon, esophagus, stomach, and rectum. But this has not been confirmed.
-Aspirin use can cause bleeding. Most common site of major bleeding (bleeding leading to death, transfusion, or surgery) was the gastrointestinal tract. It can cause minor bleeding like nose bleeds and bruising as well.

Aspirin is also called Acetylsalicylic Acid, derivative of salicylic acid that is a mild, non-narcotic pain killer useful in the relief of headache and muscle and joint aches. Aspirin is also effective in reducing fever, inflammation, and swelling and thus has been used for treatment of rheumatoid arthritis, rheumatic fever, and mild infection.

German chemical and pharmaceutical company founded in 1863 by a chemical salesman, Friedrich Bayer (1825-80), and now operating plants in Germany and more than 30 other countries was the first developer and marketer of aspirin (1899), says Encyclopædia Britannica

Aspirin has been with us for over hundred years. It is cheap and universally available. It has many health benefits. But it is not completely safe. So, before you start taking aspirin, talk to your doctor. See if it is safe for you. And don’t forget other risk factors which require your attention. Help your doctor keep you healthy!

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