Volume 9  Number 3  November 8, 2012
Second Opinions

An Aspirin a Day: Probably a Bad Idea

Writing to his father in his final illness, Col. Wilson mentioned that his rejection of doctors was the result of lucidity, not contempt.

Gabriel Garcia Marquez (The General in his Labyrinth)

It's becoming increasingly obvious that a daily aspirin is not for everyone. Yet, millions of people, estimated at a third of middle-aged Americans continue to take a daily baby aspirin (81 mg.) in the belief it will forestall a heart attack or reduce cancer risk. In January 2012, researchers in London analyzed nine randomized control studies and reported studies of aspirin in use in the U.S., Europe, and Japan that included 100,000 subjects who had never had a heart attack or stroke. Studies were reported in Archives of Internal Medicine. During a mean follow-up of 6.0 years (S.D. 2 years) aspirin treatment reduced total heart attacks (cardiovascular events) by 3.5% with no significant reduction in cardiovascular death or cancer mortality, but there was increased risk of significant ("nontrivial") bleeding, such as hemorrhagic strokes and particularly from ulcers of 30% -including yours truly!

Despite reductions in nonfatal heart attacks (MI), the article's conclusion continues "...aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case by case-basis."

Yet, it continues to be a widespread practice by a wrongly-informed public to take a daily baby 81mg. aspirin (half an adult aspirin) in the belief that it prevents heart attacks. Bayer continues to advertise widely the illusory benefits, but not the risks of taking aspirin. I have reported previously in a newsletter, that the American Heart Association has endorsed only Bayer aspirin. According to Kramer Laboratories, Inc. (Miami), "Bayer, as we understand it, contributes over $500,000 a year to the American Heart Association.

"A blanket recommendation that everybody should take an aspirin is not a good idea" Dr. Michael LeFevre of the government-backed U.S. Preventive Services Task Force told Reuters Health last year. He added that the drug is probably overused by healthy people. The task force currently advises that men age 45 to 79 take aspirin to stave off heart attacks as long as the benefit outweighs the risk of bleeding. For women age 55 to 79, the medication is recommended to prevent strokes, with the same caveat. This blunt and unproven advice was questioned by a reporter Frederik Joevling who went ahead and questioned the CDC, asking the press officer if the agency is now broadly promoting aspirin to healthy people. Here's what followed:

"We generally recommend this," he told me (Joevling), "but always include a caveat to include an ability to take aspirin as well as to consult your healthcare provider." When pressed, the press officer referred Joevling to Dr. Janet Wright, the executive director of the CDC's Million Hearts Initiative." In a phone interview, she readily acknowledged that the email was wrong and that she hadn't seen it before it went out. "Frankly, the aspirin thing can be so confusing to people," Wright told Joevling. "I'm so glad you were a filter before this got out." "That's debatable; presumably, I was just one of many journalists who got the CDC's Million Hearts pitch."

According the American Journal of Medicine reported by Reuters, a closer look at the data shows 1,111 people would need to take aspirin daily for the duration of the trials-six to eight years-to stave off just one death. A most valuable statistic, the so-called "number needed to treat."

Martin F. Sturman, MD, FACP

Copyright 2012, Mathemedics, Inc.

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