An Aspirin a Day Keeps the Doctor Away?



CONFLICTING MEDICAL advice abounds: different doctors advise either taking more calcium or less; other professionals recommend either walking with a weighted vest to increase bone strength or losing weight to preserve my troubled knees. But the most adamant docs weigh in on opposite sides of daily low-dose (81 mg) aspirin.

Reasons against taking it for me include evidence of slight GI bleeding and low ferritin (precursor to iron), which together might be causing fatigue. Aspirin increases the risk of stomach irritation and bleeding as well as of developing a stomach ulcer. It can also cause problems with breathing, indigestion, tinnitus (ringing in the ears) and hearing loss.

But the reasons in favor keep growing. Number one is protection against colon cancer, for which I’m at risk based on my mother’s cancer and on occasional polyps found during colonoscopies.

For the first time in the fall of 2015, the U.S. Preventive Services Task Force (USPSTF) recommended the use of aspirin for adults in their 50s and older with risk factors for colorectal cancer; until then, it had been recommended for people at risk of cardiovascular disease, including heart attacks and strokes.

“The change in recommendations by the USPSTF reflects the accumulation of scientific evidence linking aspirin with a lower risk of colorectal cancer,” a USPSTF spokesperson told Elizabeth Mendes on the American Cancer Society site. “There is now definitive evidence that long-term daily aspirin use, even at low doses, will lower risk of developing colorectal cancer, probably by approximately 40%,” the spokesperson said. Even the possible delay of “several years” before the benefit “kicks in” was built into the risk-benefit calculations.

Soon after this recommendation came out, even stronger evidence emerged, based on analyzing data from 135,965 health-care professionals followed for over 30 years. Participants who took aspirin, including low-dose versions, at least twice a week were 19% less likely to have gotten a colorectal cancer diagnosis, and 15% less likely to have developed any gastrointestinal cancer. “The researchers noted that the apparent cancer-protective benefits of aspirin required at least six years of regular use,” according to The Washington Post.

In the same study, the overall risk of developing cancer was 3% less for those who regularly took aspirin. Other researchers have noted the risk-lowering effect of regularly taking aspirin on developing cancers of the esophagus and stomach, and there is some evidence for breast cancer — although that has not yet been supported by randomized trials.

For cardiovascular disease, aspirin reduces the ability of the platelets to clump and clot, lowering the risk of heart attack or stroke. While it can help prevent a clot-related (ischemic) stroke, however, aspirin could also increase the risk of a bleeding (hemorrhagic) stroke.

Additional evidence suggests the salicylic acid in aspirin can help block the development of neurodegenerative diseases, including Alzheimer’s. Similar to the action of one anti-Parkinson’s drug, salicylic acid can bind with the enzyme GAPDH, interfering with its role in cell death and thereby helping maintain healthy levels of intracellular signaling.

GAPDH’s more familiar role is in glucose metabolism, and higher blood glucose levels have been associated with the risk of dementia. Although cause and effect relationships are not yet clear, the brain is clearly a “target organ for damage by high blood sugar,” according to Dr. Medha Munshi at Joslin Diabetes Center in Boston.

Another target of salicylic acid is the protein HMGB1, which causes inflammation associated with arthritis, as well as certain cancers and atherosclerosis. Even more potent than the salicylic acid in aspirin is a natural form found in the Chinese medical herb licorice.

Finally, aspirin appears to increase protection against dying from staph infection, associated in one small study with a 42% lower risk of death. While aspirin is not advised for healthy people with no risk of GI cancer or cardiovascular disease, because of the risk of GI bleeding, I consider myself fortunate to be in the recommended group for all of the possible additional benefits listed above.

— Mary Carpenter
Mary Carpenter is the Well-Being Editor of MyLittleBird.
Read more about Mary.

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