Should we ALL take an aspirin? As a new study proves the astonishing powers of the everyday 'wonder drug', our team of experts reveal how it could save your life

TCR NEWS
30 May 2016



Should we ALL take an aspirin? As a new study proves the astonishing powers of the everyday 'wonder drug', our team of experts reveal how it could save your life


IT'S GOOD FOR... 


1 EASING SYMPTOMS OF MIGRAINE


We’ve probably all used this all-rounder drug for aches and pains to ease headaches, muscle pain and toothache.


First developed to treat arthritis pain, aspirin belongs to a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs), as does ibuprofen.


These drugs dampen inflammation by blocking pain-producing chemicals called thromboxanes.


Aspirin differs from paracetamol, which has no anti-inflammatory effect and works on a different pain trigger, the chemical cyclooxygenase. There is emerging evidence that aspirin can be used to tackle the serious headache-type condition migraine.


HOW TO TAKE IT: Consultant cardiologist Dr Laura Corr says a higher dose of aspirin – three normal 300mg tablets – can be useful for reducing or relieving the symptoms of an acute migraine attack.


The recommended dose for pain relief is high – 300mg to 900mg every four to six hours. But you shouldn’t exceed 4g daily.


Aspirin works for more than half of sufferers. ‘It’s cheap and readily available over the counter and is as effective as low doses of the prescription-only migraine medicines such as sumatriptan,’ says Dr Corr, of the Harley Street Clinic.


‘As with many of the effects of aspirin, we don’t know exactly how it works. But it not only relieves headache pain but also many other migraine symptoms such as visual disturbances.’


2 AVOIDING HEART ATTACKS


The blood contains tiny cell fragments called platelets that play a crucial role in blood clotting. These can cluster together due to the development of cardiovascular disease brought on by a range of factors including diet, weight, genetic risk, lifestyle, blood pressure and blood cholesterol levels.


If this happens, it can cause clots that block arteries and trigger heart attacks, when part of the heart muscle is starved of oxygen and dies.


What aspirin does is thin the blood by reducing platelets clustering, therefore preventing attacks.


HOW TO TAKE IT: Guidance issued in the US in April this year by a government-backed panel of independent physicians (the US Preventive Services Task Force) says that adults aged 50 to 59 at risk of heart attack should take a low dose of aspirin daily ‘as an insurance policy’. That group includes anyone with high blood pressure or high cholesterol.


Dr Corr, though, says the advice in the UK is more cautious, with aspirin recommended only for those who have already had heart problems. ‘Although many people take low doses of aspirin – 75mg – every day to prevent heart attacks, the evidence that this does you more good than harm is lacking.


‘It’s now generally recommended only for people who have already had a heart attack or suffer angina, or those who have had treatment with stents or bypass surgery.’


3 PROTECTING YOU FROM CANCER


Scientists are also turning to aspirin in the battle against cancer. Although it is not fully understood, the theory is that aspirin hinders platelets from protecting cancer cells in the body.


HOW TO TAKE IT: A major study by experts from centres in the US and Europe found that taking aspirin daily for a decade can cut cancer risk. The findings, published in the Annals Of Oncology in 2014, show that not much happens in the first five years but after that stomach, oesophageal and colorectal cancer all reduce by about a third.


For lung, prostate and breast cancer it’s around ten per cent, according to Professor Jack Cusick, who was involved in the research which was based on people between 50 and 65.


 ‘If you put all this together, then aspirin is the second most important thing in preventing cancer,’ says Prof Cusick, head of the centre for cancer prevention at Queen Mary University of London.


‘It takes five years but the benefits are quite striking. A low dose of 75mg of aspirin is something to consider for people in this age group, apart from those with bleeding risks. What’s needed is a change in mindset to recognise the benefits of aspirin in combating cancer.’ If you are in this age group and are concerned that you may be at an increased risk of these cancers, for instance due to family history, discuss with your GP whether you may benefit from low-dose aspirin.


4 REDUCING RISK OF MINI-STROKES


Taking aspirin after minor strokes could limit the harm caused by further strokes. That’s according to a University of Oxford study published this month based on data from 15 aspirin trials involving 56,000 stroke patients.


Aspirin’s role in reducing stroke risk or mini-stroke has long been proven, says consultant Inderpaul Birdi. He explains that it helps stop the formation of clots, which block blood vessels in the brain and cause strokes


HOW TO TAKE IT: Mr Birdi, cardiac surgeon at Basildon and Thurrock University Hospitals, says: ‘Many patients are on aspirin for the prevention of recurrent stroke or mini-stroke. Aspirin inhibits clots forming where the arteries are furred up.’


He says that recent guidance from NHS drugs watchdog the National Institute for Health and Care Excellence suggests that a prescription anti-clotting drug called Clopidogrel should be used as a preferred stroke-prevention drug in these patients.


He adds: ‘If aspirin is used, it should be combined with the drug dipyridamole as this combination is more effective than aspirin alone.’


5 PREVENTING MISCARRIAGE


Women with conditions that make them prone to clotting, such as Hughes syndrome, also known as sticky blood, face the misery of recurrent miscarriage.


Peter Bowen-Simpkins, medical director of London Women’s Clinic, says the theory is that the blood-thinning properties of aspirin ‘prevent tiny clots forming in the blood vessels leading to the womb that can kill off a pregnancy’.


HOW TO TAKE IT: Several studies have suggested that a daily dose of aspirin combined with the blood-thinner heparin can reduce the risk. 


High blood pressure – or pre-eclampsia – during the second half of pregnancy also puts women at risk of miscarriage. A review of existing trials by the US Preventive Services Task Force in 2014 found that daily low-dose aspirin could reduce the risk by nearly a quarter.


Obstetrician and gynaecologist Clive Spence-Jones, from the Portland Hospital, says: ‘It’s not for everyone but could benefit high-risk mothers who have previously had pre-eclampsia and problems affecting the baby, such as prematurity and slow growth.’


There is no evidence of any wider benefit for women having problems conceiving in general, according to Mr Bowen-Simpkins. All pregnant women should seek medical advice before taking any medication.


 IT'S BAD FOR...


1 HAEMOPHILIACS AND CHILDREN


Aspirin is a powerful medication and, as with all drugs, it can have side effects. There are also a number of people who cannot take it, including:


l Those who have had an allergic reaction to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, in the past


l Asthma sufferers


l Anyone who has had stomach ulcers, or severe liver or kidney problems


l Those with haemophilia or another blood disorder, or who have uncontrolled high blood pressure.


Cardiologist Inderpaul Birdi explains that aspirin is not recommended for general daily use, given the evidence linking it to internal bleeding. ‘This suggests that the benefits in healthy people are heavily outweighed by the risk of gastrointestinal irritation and bleeding,’ says Mr Birdi.


The drug is also not recommended for children under the age of 16 because of the risk of the very rare but serious complication of Reye’s syndrome, which causes swelling in the liver and brain.


2 SUFFERERS OF ATRIAL FIBRILLATION 


About 50,000 people a year are diagnosed with an irregular and abnormally fast heart rate – classified as more than 100 beats per minute – which is also known as atrial fibrillation (AF). GPs still prescribe aspirin for about a third of AF patients at increased risk of stroke.


However, according to new guidance from NICE published last year, doctors should be switching them to newer anticoagulant drugs (NOACs). 


The reason is that aspirin is not as effective in preventing stroke, and the bleeding risk negates any benefits, according to Jeremy Pearson, medical director at the British Heart Foundation.


‘Aspirin shouldn’t be used by AF patients because the risks of bleeding in the gut outweigh any benefits in reducing strokes,’ says Prof Pearson, from King’s College London.


‘GPs should be putting people [at high risk of stroke] on anticoagulant drugs unless they need to take aspirin for other reasons. Always talk through your treatment with your doctor.’


3 ‘ECONOMY-CLASS SYNDROME'


Although aspirin is effective in preventing blood clots that form in arteries – which lead to heart attacks and strokes – the drug is not effective in breaking down clots that block veins.


This means it will not prevent a venous thromboembolism (VTE), a condition where parts of blood clots in the legs – a deep-vein thrombosis, or DVT – break off and travel to the blood vessels between the heart and lungs, causing a potentially fatal blockage.


Typically, VTEs occur after periods of prolonged inactivity (such as in a cramped flight or hospital bed). Dehydration, being overweight and older age increase the risk.


Clots in veins are not triggered by platelets, so drugs other than aspirin are needed to stop them forming, says Duncan Dymond, consultant cardiologist at St Bartholomew’s Hospital in London. However, anyone already prescribed aspirin should keep taking it when they fly.


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