Aspirin Update

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Not too long ago, the news media contained a story about aspirin use and the risks of gastrointestinal bleeding. Aspirin has long been known to reduce the risk of developing heart disease but the advice from this item in the news recommended stopping aspirin use because of the risk of bleeding. As I watched the story that ran on a local TV station, I realized that the story was not 100% accurate and might be misleading. Today I would like to clarify the story. On April 26 of this year the Journal of the American Medical Association published three articles from the U.S. Preventive Services Task Force (USPSTF) on the use, risks, and benefits of using aspirin to prevent heart disease. The USPSTF, a quasi-governmental assembly of medical experts, routinely reviews clinical studies and research data on the prevention of and screening for various conditions and diseases and publishes their findings.

Each year in the U.S., more than one million people will experience their first episode of cardiovascular disease (CVD - stroke and heart attack) and nearly 150,000 will develop colorectal cancer. Many studies have proven that aspirin imparts a small but significant improvement in the risk of developing CVD plus a probable small protective effect in developing colorectal cancer. Aspirin also increases the probability of gastrointestinal (GI) bleeding in people who are not already at risk for bleeding. Those who have an increased risk of GI bleeding (e.g., history of prior GI bleeding or ulcers) should not take aspirin. The risk of CVD as well as colon cancer rises as a person ages, starting at about age 40. The risk of developing CVD also depends on other factors such as cigarette smoking, family history, diet, weight, and other diseases like diabetes and hypertension. The risk of colon cancer is also increased by smoking, diet (processed meats), and family history.

Getting back to the USPSTF recommendation, they do not dispute the fact that aspirin has a small but positive effect on the risk of CVD as well as an even smaller positive effect on the risk of colon cancer. They correctly point out that the risk of GI bleeding from aspirin rises as one ages. They do not recommend the cessation of aspirin use in those who are already on it. What is new since the last time the USPSTF reviewed this subject is this: They recommend that due to the rise in bleeding risk from aspirin as one ages, anyone age 60 and over who is not already on aspirin should not begin an aspirin regimen to prevent CVD and colon cancer because by age 60 the risk of bleeding outweighs the potential advantages.

Meanwhile, if you or someone you know is on aspirin, do not stop taking it without first speaking to your doctor. Stopping or starting medication on your own without input from your doctor is never a good idea. Finally, this USPSTF recommendation only applies to primary prevention (preventing disease in someone without it). It does not apply to secondary prevention (preventing worsening disease in someone with it).

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 By Peter Galvin, MG

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