Aspirin’s Dangers Outweigh the Benefits

Aspirin has been widely recommended as a preventative therapy for cardiovascular disease (CVD) since the early 1980s, but that recommendation is now being challenged. Previous studies have demonstrated an overuse of aspirin in primary care patients. In January of 2015, however, the Journal of the American College of Cardiology (JACC) published a study documenting the inappropriate use of aspirin therapy among low risk cardiology patients, showing that the very serious risk of gastrointestinal (GI) tract bleeding and stroke outweighed any possible cardiovascular benefit. The study concludes that as many as one in ten patients may be taking aspirin “inappropriately,” without clinical history of CVD sufficient to warrant the risk. Additionally, if patients also have type 2 diabetes, their risk of ischemic stroke increases to an alarming 70 percent, according to a Korean study, suggesting that low-dose aspirin therapy should be re-evaluated in diabetic patients.

In a recent survey conducted by the American Journal of Preventative Medicine, 47 percent of adults polled between 45 and 75 years of age without a history of heart disease reported recurring use of aspirin, making them prime targets for the dangerous side effects of inappropriate use. In addition, 18 percent of users indicated the prevention of cancer as the purpose for the regular use. This additional use for aspirin followed a five-year study published in The Lancet in 2012 suggesting that patients taking a daily, low-dose aspirin may have a lower mortality rate from a number of different types of cancers, including cancers of the GI tract and colon. Other studies, including clinical trials and one report published in the Journal of the American Medical Association, contradict those conclusions.

The concerns over excessive bleeding with aspirin are not new. In 1971, a large-scale, double-blind study involving cardiovascular patients and aspirin use to prevent heart attack had to remove the double-blinding due to a suggestion by Hirschel Jick, an American epidemiologist, that the reason fewer aspirin-takers were admitted to the hospital may be related to their death before arriving at the hospital. The study’s initiator, Peter Elwood, was able to initially rule out the possibility, but even when the study ended in 1973, it only showed a nominal reduction in heart attacks among the participants using aspirin. By the 1980s, studies and clinical trials had concluded concretely in favor of aspirin’s benefits and the U.S. Food and Drug Administration had given its approval, putting aspirin back in favor with cardiologists.

Although aspirin has now been identified as dangerous for recurring therapy in those without a history of heart disease, it is still recommended as beneficial for those who have already suffered a cardiac event or are at risk within a 10 year period for CVD. According to The Columbus Dispatch Dr. Frank Tice, medical director for non-invasive cardiac imaging at Mount Carmel East and West hospitals, worries about the overuse of aspirin. “It’s not a free ride. It does have side effects.” He agrees that these conclusions do not negate aspirin’s role in the primary prevention of heart attack, but he hopes the new studies will prompt cardiologists to examine individual patient history and risk before recommending daily aspirin therapy.

In an interview with ABC News , Dr. Walter Cair, interim executive medical director of the Vanderbilt Heart and Vascular Institute, said that he often sees patients who are self-prescribing aspirin for a conditions such as an irregular heartbeat when they do not need it. “When I delve into why, they confuse the fact because they have an electrical problem, they have a plumbing problem,” he added.

“For every two events it prevents, it’s at the cost of one major bleed. I certainly am not a big proponent of aspirin given the current data to prevent first heart attacks,” says Dr. Ragavendra Baliga, an editor for the JACC and a cardiologist at Ohio State University’s Wexner Medical Center.

Marcus Russell, a personal strength coach and weight management specialist in Los Angeles, believes that the phenomena of relying on a medication to replace physical exercise is a symptom of a sedentary lifestyle. “The penchant for Americans to self-medicate and the desire for Pharmaceutical companies to re-purpose existing drugs meant this was a long time coming,” he said in a recent interview.

The American Heart Association (AHA) points to a sedentary lifestyle as one of the five major factors of CVD, including blood pressure, obesity, abnormal blood lipid values, and smoking, all of which can be positively impacted by lifestyle changes such as exercise. In fact, the exercise recommendations by the Surgeon General seem notably modest. However, more than a third of Americans remain sedentary according to the AHA despite the fact that significant improvements are achieved when going from a sedentary lifestyle to a moderately active one in terms of preventing CVD and long-term mortality rates.

“The human heart is a muscle, so you need to place it under stress from time to time (with a doctor’s supervision if you have a history of heart disease). Ample amounts of anaerobic training and resistance training will increase vasodialation, reduce blood pressure and resting heart rate. Humans existed for millions of years without aspirin so it can go another million without it,” says Russell.

Dr. Baglia seems to agree with that assessment. “I’ve always said that if you want to prevent, do the lifestyle things: exercise, stop smoking, diet.”

(Editor’s note: While there are increasing doubts about the efficacy of aspirin therapy with respect to preventing a first heart attack, nothing in this article should be construed as an excuse for not taking palliative aspirin doses if prescribed by a physician. Nevertheless, you should always keep a vial of uncoated baby aspirin on hand because, while aspirin may not be effective in preventing a first heart attack, it could save your life …or save someone else’s life…during a cardiovascular event. After all, who cares about gastritis when you are in the middle of having a heart attack? Remember to chew the aspirin rather than swallowing them whole.)

Photo Credit: By 14 Mostafa&zeyad (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

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