Monday 21 November 2022 10:17 PM Is aspirin a wonder pill or does it do more harm than good? trends now

Monday 21 November 2022 10:17 PM Is aspirin a wonder pill or does it do more harm than good? trends now
Monday 21 November 2022 10:17 PM Is aspirin a wonder pill or does it do more harm than good? trends now

Monday 21 November 2022 10:17 PM Is aspirin a wonder pill or does it do more harm than good? trends now

Forty years ago a bountifully cheap painkiller was hailed as a wonder drug for preventing heart disease by making blood less sticky and thus less liable to form artery-clogging clots.

Doctors began to recommend that anyone over the age of 55 who worried they were at risk of a heart attack could opt to take the drug daily.

Then, eight years ago, this same medicine was proclaimed to be one of our best weapons against cancer, thanks to its ability to reduce levels of cell-damaging inflammation in our bodies. Again, some doctors began to recommend taking a daily preventive dose.

That drug is aspirin, which is now taken once a day in low doses of 75mg to 100mg by millions as a preventive therapy for circulatory diseases and cancers, and by countless others in high doses (300mg and above) for pain, headache and fever.

This humble ‘wonder pill’ costs less than a penny to make — some 40,000 tonnes of the medicine (almost four times the weight of the Eiffel Tower) are produced globally each year. But aspirin’s glittering star is now in danger of fading.

New research is increasingly reinforcing warnings that the drug’s side-effects, which include internal bleeding and gastric ulcers, are so prevalent that the risks of taking even daily low-dose aspirin can, for many people, seriously outweigh any benefits in preventing serious illness.

Nevertheless, some doctors maintain that significant numbers of patients should still benefit from a daily dose.

Indeed, one leading UK-based researcher passionately maintains that aspirin has not been trialled fairly and we are all missing out on its potential life-saving benefits.

Forty years ago a bountifully cheap painkiller was hailed as a wonder drug for preventing heart disease by making blood less sticky and thus less liable to form artery-clogging clots. Doctors began to recommend that anyone over the age of 55 who worried they were at risk of a heart attack could opt to take the drug daily

Forty years ago a bountifully cheap painkiller was hailed as a wonder drug for preventing heart disease by making blood less sticky and thus less liable to form artery-clogging clots. Doctors began to recommend that anyone over the age of 55 who worried they were at risk of a heart attack could opt to take the drug daily

The mixed messages have left many in a dilemma, wondering whether they should ditch the daily pill that doctors had been urging them to take until recently.

Salicylic acid, the natural substance that is the key ingredient in aspirin, is found in willow tree bark. It is cited in 4,000-year-old scripts as a painkilling salve for rheumatism. Hippocrates, the Ancient Greek father of medicine, recommended it for fever, pain and childbirth.

Meadowsweet, another plant source of salicylic acid, was a sacred herb to British Druids and is mentioned by Chaucer in the 14th century.

In the 1700s, an English clergyman, the Reverend Edward Stone, performed the first scientific study of willow bark and wrote to the Royal Society saying he had used it successfully to treat fever in 50 of his parishioners.

But it was a German chemist, Dr Felix Hoffmann, who invented a lab-made version of the meadowsweet ingredient, acetylsalicylic acid, in 1897 as a painkilling drug. This spawned today’s pharmaceutical industry.

The compound was registered as Aspirin (the ‘A’ comes from acetyl and the ‘spir’ from meadowsweet’s scientific name at the time, Spiraea ulmaria).

Can a low dose prevent cancer?

After World War II, doctors around the world began to notice that patients regularly taking aspirin for chronic pain had lower rates of heart disease.

And in 1980, Professor Richard Peto, an epidemiologist at Oxford University, published an analysis of six studies and concluded that people on aspirin lowered their risk of dying from vascular disease by nearly a quarter.

More recently, aspirin acquired renown for another preventive power. Around a decade ago, researchers began to conclude that aspirin’s anti-inflammatory properties meant that in low doses it could also prevent chronic damage to cells that can cause them to turn rogue and become cancerous.

In 2014, Jack Cuzick, a professor of epidemiology at Queen Mary University of London, wrote a review suggesting that more than 130,000 deaths from cancer would be avoided in the UK if everyone aged 50 to 64 took a low-dose aspirin daily.

The effects were greatest for bowel, stomach and oesophageal cancers, he said, with smaller effects for prostate, breast and lung cancers.

‘The second most important thing you can do to prevent cancer, after not smoking, is to take a low-dose aspirin,’ Professor Cuzick told journalists in 2015.

Since then, however, aspirin’s wonder-drug status has fallen into doubt.

For example, in 2016 a consortium of British, Spanish and U.S. researchers analysed results from 39 studies and warned that the risks of bleeding from low-dose aspirin regimens may outweigh their benefits in preventing cardiovascular disease, reported the journal PloS One.

Since then, fears have steadily accumulated, to the point where in April, a key expert panel — the U.S. Preventive Services Task Force (USPSTF) — declared that people over 60 should not use daily aspirin to prevent a first heart attack because the benefit is outweighed by the potential risk of internal bleeding.

More recently, aspirin acquired renown for another preventive power. Around a decade ago, researchers began to conclude that aspirin’s anti-inflammatory properties meant that in low doses it could also prevent chronic damage to cells that can cause them to turn rogue and become cancerous

More recently, aspirin acquired renown for another preventive power. Around a decade ago, researchers began to conclude that aspirin’s anti-inflammatory properties meant that in low doses it could also prevent chronic damage to cells that can cause them to turn rogue and become cancerous

Risk of bleeding more easily 

This is a reversal of the guidance written by the same panel in 2009, which encouraged doctors to prescribe low-dose aspirin for preventing a first heart attack in men aged 45 to 79, and for the prevention of stroke in women aged 55 to 79.

Now the USPSTF says that the risks of internal bleeding from aspirin are higher than previously thought, and that those aged 40 to 59 must only take the medication daily if they are at a genetic risk of heart disease and after consulting a doctor.

Those over 75 should not take the drugs because there is little benefit in older age, it adds.

The NHS says you should only take daily low-dose aspirin if your doctor recommends it because of a high risk of heart attack or stroke, and warns that because aspirin helps to stop blood from clotting, taking it daily can make us bleed more easily.

It even cautions those taking it to be ‘careful when doing activities that might cause an injury or a cut. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth.’

The NHS also warns that, as well as causing intestinal bleeding, taking aspirin regularly can cause ulcers in the gut by damaging the stomach and intestinal lining.

The latest study to raise concerns about aspirin taken preventatively was published this month.

Australian researchers monitored more than 16,700 people aged over 70 for more than four-and-a-half years and found that those who took a daily low-dose aspirin had significantly raised risks of serious injury or fatality after a fall compared with older people who didn’t.

The study, published in the journal JAMA Internal Medicine, revealed that the drug made older people nearly 10 per cent more likely to have a fall that required hospital care.

This may be related to the drug’s anticoagulant effect: people who fall while taking aspirin may have considerable bleeding or bruising, prompting emergency care.

So is that it for preventive aspirin? Experts say that the picture is complicated.

The NHS says you should only take daily low-dose aspirin if your doctor recommends it because of a high risk of heart attack or stroke, and warns that because aspirin helps to stop blood from clotting, taking it daily can make us bleed more easily

The NHS says you should only take daily low-dose aspirin if your doctor recommends it because of a high risk of heart attack or stroke, and warns that because aspirin helps to stop blood from clotting, taking it daily can make us bleed more easily

Professor Colin Baigent, a director of the Medical Research Council (MRC) Population Health Research Unit at Oxford University has been studying data on preventive aspirin since 1994.

‘Giving it to apparently healthy people is a very controversial matter,’ he told Good Health.

He explains that modern UK and EU guidelines recommend not giving daily aspirin to people who have not previously suffered a heart attack or stroke. ‘But for people who have already got a history of cardiovascular disease then aspirin is recommended for longer-term prevention of recurrent heart attack or stroke, because they are at high risk.’

However, he adds that the evidence

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