Researchers at Warwick Medical School have published the most comprehensive review of the benefits and risks of a daily dose of prophylactic aspirin and warn that greater understanding of side effects is needed.
The possible benefits of a daily dose have been promoted as a primary prevention for people who are currently free of, but at risk of developing, cardiovascular disease or colorectal cancer.
However, any such benefit needs to be balanced alongside a fuller understanding of the potentially harmful side effects such as bleeding and gastrointestinal problems.
The paper, published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme, reviews the wealth of available randomised controlled trials (RCTs), systematic reviews and meta-analyses, allowing the team from Warwick Evidence to quantify those relative benefits and risks.
The reported benefits of taking aspirin each day ranged from 10% reduction in major cardiovascular events to a 15% drop in total coronary heart disease. In real terms, that would ultimately mean 33-46 fewer deaths per 100,000 patients taking the treatment.
There was also evidence of a reported reduction in incidents of colorectal cancer, which showed from approximately five years after the start of treatment. This would equate to 34 fewer deaths from colorectal cancer per 100,000 patients.
The adverse effects of aspirin were also noted with a 37% increase in gastrointestinal bleeding (an extra 68-117 occurrences per 100,000 patients) and between a 32%-38% increase in the likelihood of a haemorrhagic stroke (an extra 8-10 occurrences per 100,000 patients).
Aspirin for Primary Prevention in Men When Cancer Mortality Benefit Added
A research team, including UNC scientists, reports that including the positive effect of aspirin on cancer mortality influences the threshold for prescribing aspirin for primary prevention in men. The benefit of aspirin for cancer mortality prevention would help offset the risks and thus lower the age and increase the number of men for whom aspirin is recommended.
Aspirin May Lower Melanoma Risk
Overall, women who used aspirin had a 21 percent lower risk of melanoma relative to non-users. Each incremental increase in duration of aspirin use (less than one year of use, one to four years of use, and five or more years of use) was associated with an 11 percent lower risk of melanoma. Thus, women who used aspirin for five or more years had a 30 percent lower melanoma risk than women who did not use aspirin. The researchers controlled for differences in pigmentation, tanning practices, sunscreen use, and other factors that may affect skin cancer risk.Aspirin Every Other Day May Lower Women's Colon Cancer Risk
Taking a low-dose aspirin every other day may reduce the risk of colorectal cancer, according to a study that focused on nearly 40,000 women aged 45 and older.
The protection does seem to take some time to surface, said researcher Nancy Cook, a professor of medicine at Brigham and Women's Hospital and Harvard Medical School. "After 10 years, we started to see an effect," she noted.
"After 18 years of follow-up, we saw a 20 percent reduction in colon cancer over the whole time period," she said. When they looked at the 10-to-18 year mark, the reduction was 42 percent, she said.
Aspirin use = lower risk of death from chronic liver disease
Aspirin use is associated with a decreased risk of developing hepatocellular carcinoma and death from chronic liver disease (CLD), according to a study published November 28, 2012 in the Journal of the National Cancer Institute. Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, occurs mainly among patients with CLD.
Study participants who used aspirin had a 41% reduced risk of HCC and a 45% reduced risk of death from CLD, whereas those who used non-aspirin NSAIDs experienced a 26% reduced risk of CLD mortality but no reduced risk of HCC.
Aspirin blocks tumor growth in some colorectal cancer
Aspirin has the potential to block tumor growth in certain patients with colorectal cancer, according to an editorial in the Oct. 25, 2012 issue of the New England Journal of Medicine by a University of Alabama at Birmingham oncologist. In a study that appears in the same issue, researchers examined the use of aspirin in the treatment outcomes of patients with colorectal cancer and a certain gene mutation. The authors found that the use of aspirin after diagnosis in patients with the gene mutation was associated with a 46 percent reduction in overall mortality and an 82 percent reduction in colorectal cancer-specific mortality.
Aspirin may decrease risk of aggressive form of ovarian cancer
Aspirin May Slow Brain Decline
Aspirin use and the risk of prostate cancer mortality
Study: daily aspirin linked to lower cancer mortality
For the current study, American Cancer Society researchers led by Eric J. Jacobs, Ph.D., analyzed information from 100,139 predominantly elderly participants in the Cancer Prevention Study II Nutrition Cohort who reported aspirin use on questionnaires, did not have cancer at the start of the study, and were followed for up to 11 years. They found daily aspirin use was associated with an estimated 16% lower overall risk of cancer mortality, both among people who reported taking aspirin daily for at least five years and among those who reported shorter term daily use. The lower overall cancer mortality was driven by about 40% lower mortality from cancers of the gastrointestinal tract (such as esophageal, stomach, and colorectal cancer) and about 12% lower mortality from cancers outside the gastrointestinal tract.
The reduction in cancer mortality observed in the current study is considerably smaller than the 37% reduction reported in the recent pooled analysis of randomized trials. The authors note that their study was observational, not randomized, and therefore could have underestimated or overestimated potential effects on cancer mortality if participants who took aspirin daily had different underlying risk factors for fatal cancer than those who did not. However, the study's large size is a strength in determining how much daily aspirin use might lower cancer mortality
Aspirin use responsible for a 57 percent reduction in the risk of prostate cancer death
Aspirin and omega-3 fatty acids work together to fight inflammation
Statin and Aspirin Use Linked to Improved Survival in Women with Endometrial Cancer
Regular use of low-dose aspirin may prevent the progression of breast cancer
Aspirin reduces risk of Barrett's esophagus & cancer
Aspirin use appears to reduce the risk of Barrett's esophagus (BE), the largest known risk factor for esophageal cancer, according to a new study (July, 2012) in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Those taking aspirin were 44 percent less likely to have BE.
Aspirin before heart surgery reduces the risk of post-operative acute kidney failure
Aspirin May Guard Against Skin Cancer
Colon Cancer Survival Improves With Aspirin
Colon cancer patients who take aspirin regularly shortly after diagnosis tend to live longer, researchers from Leiden University Medical Centre, the Netherlands, reported in the British Journal of Cancer. (April, 2012) Those taking a daily dose of aspirin for nine months or more after diagnosis had a 30% lower risk of cancer-related death compared to non-users. Even taking aspirin regularly for any length of time reduced the risk of death (by 23%).
Aspirin's potential role in reducing the risk of cancer death
A new report by American Cancer Society scientists says new data showing aspirin's potential role in reducing the risk of cancer death bring us considerably closer to the time when cancer prevention can be included in clinical guidelines for the use of aspirin in preventive care. The report, published early online in Nature Reviews Clinical Oncology (April, 2012), says even a 10% reduction in overall cancer incidence beginning during the first 10 years of treatment could tip the balance of benefits and risks favorably in average-risk populations.
Current guidelines for the use of aspirin in disease prevention consider only its cardiovascular benefits, weighed against the potential harm from aspirin-induced bleeding. While daily aspirin use has also been convincingly shown to reduce the risk of colorectal cancer and recurrence of adenomatous polyps, these benefits alone do not outweigh harms from aspirin-induced bleeding in average-risk populations. But recently published secondary analyses of cardiovascular trials have provided the first randomized evidence that daily aspirin use may also reduce the incidence of all cancers combined, even at low doses (75-100 mg daily).
The report says recently published meta-analyses of results from randomized trials of daily aspirin treatment to prevent vascular events have provided provocative evidence that daily aspirin at doses of 75 mg and above might lower both overall cancer incidence and overall cancer mortality.
Why Don't More Women Take a Daily Aspirin to Prevent Heart Disease?
Heart disease is the leading cause of death among women, and evidence-based national guidelines promote the use of daily aspirin for women at increased risk for cardiovascular disease. However, less than half of the women who could benefit from aspirin are taking it,.
Aspirin: High or Low Dose? No significant difference.
Aspirin lowers trans fat-related stroke risk in older women
Older women whose diets include a substantial amount of trans fats are more likely than their counterparts to suffer an ischemic stroke, a new study shows.
However, the risk of stroke associated with trans fat intake was lower among women taking aspirin, according to the findings from University of North Carolina at Chapel Hill researchers.
The study of 87,025 generally healthy postmenopausal women aged 50 to 79 found that those whose diets contained the largest amounts of trans fats were 39 percent more likely to have an ischemic stroke (clots in vessels supplying blood to the brain) than women who ate the least amount of trans fat. The risk was even more pronounced among non-users of aspirin: those who ate the most trans fat were 66 percent more likely to have an ischemic stroke than females who ate the least trans fat.
However, among women who took aspirin over an extended period of time, researchers found no association between trans fat consumption and stroke risk – suggesting that regular aspirin use may counteract trans fat intake's adverse effect on stroke risk among women.
Regular aspirin intake halves hereditary cancer risk
Higher daily dose of aspirin prevents heart attacks
Using information from diabetic patients in these studies, Simpson discovered that patients with previous cardiac episodes who were taking a low dose of aspirin daily had very little benefit in terms of prevention of a second heart attack or a decreased risk of mortality. However, in patients taking higher doses of aspirin, the risk of a repeat heart attack and/or death was significantly lower.
Aspirin reduces the risk of cancer recurrence in prostate cancer patients
After 10-years from completion of treatment, 31% of the men who took aspirin developed recurrence compared with 39% of non-aspirin users. There was also a 2% improvement in 10-year prostate cancer related survival associated with aspirin use
Aspirin may lower the risk of pancreatic cancer
Results showed that people who took aspirin at least one day during a month had a 26 percent decreased risk of pancreatic cancer compared to those who did not take aspirin regularly. The effect was also found for those who took low-dose aspirin for heart disease prevention at 35 percent lower risk.
Daily Aspirin at Low Doses Reduces Cancer Deaths
A daily low dose of aspirin significantly reduces the number of deaths from a whole range of common cancers, an Oxford University study has found.
The 20% drop in all cancer deaths seen in the study adds new evidence to the debate about whether otherwise healthy people in their 40s and 50s should consider taking a low dose of aspirin each day.
Aspirin is already known to be beneficial for those at high risk of heart disease. But among healthy people, the benefit in lower chances of heart problems only marginally outweighs the small risk of stomach bleeds.
The large size of the effect now seen in preventing cancer deaths may begin to tip the balance in favour of taking aspirin.
The results, published in the Lancet, showed that aspirin reduced death due to any cancer by around 20% during the trials. But the benefits of aspirin only became apparent after taking the drug for 5 years or more, suggesting aspirin works by slowing or preventing the early stages of the disease so that the effect is only seen much later.
After 5 years of taking aspirin, the data from patients in the trials showed that death rates were 34% less for all cancers and as much as 54% less for gastrointestinal cancers, such as oesophagus, stomach, bowel, pancreas and liver cancers.
The researchers also wanted to determine if the benefits from aspirin continued over time. By using cancer registries and death records, they were able to follow up what had happened to participants in three of the trials.
They showed that risk of cancer death over a period of 20 years remained 20% lower for all solid cancers among those who had taken aspirin (even though they would have been unlikely to have continued taking aspirin after the trials finished), and 35% lower for gastrointestinal cancers.
It took about 5 years to see a benefit in taking aspirin for oesophagus, pancreatic, brain, and lung cancer; about 10 years for stomach and bowel cancer; and about 15 years for prostate cancer. The 20-year risk of death was reduced by about 10% for prostate cancer, 30% for lung cancer, 40% for bowel cancer and 60% for oesophagus cancer.
Low dose of aspirin wards off bowel cancer
Even the lowest possible dose of aspirin (75 mg) can ward off bowel cancer, if taken regularly, finds research published online in the journal Gut.
After a year, taking daily low dose aspirin was associated with a 22% reduced risk of developing bowel cancer, and the magnitude of the reduction in risk was cumulative, rising to 30% after five years.
The benefits of aspirin treatment significantly outweigh the risk of a major hemorrhage
The American Heart Association:
“Background— Low-dose aspirin is an important therapeutic option in the secondary prevention of myocardial infarction (MI) and ischemic stroke, especially in light of its unique cost-effectiveness and widespread availability. In addition, based on the results of a number of large studies, aspirin is also widely used in the primary prevention of MI. This review provides an update of the available data to offer greater clarity regarding the risks of aspirin with respect to hemorrhagic stroke, as well as insights regarding patient selection to minimize the risk of this complication.
Summary of Review— In the secondary prevention of cardiovascular, cerebrovascular, and ischemic events, the evidence supports that the benefits of aspirin treatment significantly outweigh the risk of a major hemorrhage. The evidence from primary prevention of MI studies, including that from the recent Women’s Health Study evaluation of aspirin use in healthy women, demonstrate that the increased risk for hemorrhagic stroke is small, is comparable to the secondary prevention studies, and fails to achieve statistical significance. A reasonable estimate of the risk of hemorrhagic stroke associated with the use of aspirin in primary prevention patients is 0.2 events per 1000 patient-years, which is comparable to estimates of the risk associated with the use of aspirin in secondary prevention patients.
Conclusions— When considering whether aspirin is appropriate, the absolute therapeutic cardiovascular benefits of aspirin must be balanced with the possible risks associated with its use, with the most serious being hemorrhagic stroke.”
Another study (http://www.ynhh.org/healthlink/neurology/neurology_08_06.html ) had revealed that the 100 mg dose of aspirin every other day caused a 24 percent drop in the risk of ischemic stroke, which is the more common kind of stroke, and an insignificant increase in the risk of hemorrhagic stroke, hence the overall reduction in stroke risk of 17 percent. .
Aspirin use lowers breast & ovarian cancer risk
Breast Cancer Patients Who Take Aspirin Reduced Risk of Metastasis and Death by Half
An analysis of data from the Nurse’s Health Study, a large, ongoing prospective observational study, shows that women who have completed treatment for early-stage breast cancer and who take aspirin have a nearly 50 percent reduced risk of breast cancer death and a similar reduction in the risk of metastasis.
Aspirin can reduce risk of Alzheimer's disease
Different types of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and aspirin, appear to be equally effective in lowering the risk of Alzheimer’s disease, according to the largest study of its kind published in the May 28, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology. Experts have debated whether a certain group of NSAIDs that includes ibuprofen may be more beneficial than another group that includes naproxen and aspirin.
Using information from six different studies, researchers examined data on NSAID use in 13,499 people without dementia. Over the course of these six studies, 820 participants developed Alzheimer’s disease.
Researchers found that people who used NSAIDs had 23 percent lower risk of developing Alzheimer’s disease compared to those who never used NSAIDs. The risk reduction did not appear to depend upon the type of NSAID taken.
Aspirin at night = significant reductions in blood pressure
Data unveiled at the American Society of Hypertension's Twenty Third Annual Scientific Meeting and Exposition (ASH 2008) revealed for the first time that people with prehypertension who are treated with aspirin may experience significant reductions in blood pressure—but only if they take the pill before bedtime, and not when they wake up in the morning.
Aspirin may reduce risk of breast cancer
Aspirin can prevent liver damage that afflicts millions, Yale study finds
Using Aspirin to Prevent Heart Attack Or Stroke - U.S. Preventive Services Task Force Recommendations
Patients and clinicians should consider risk factors-- including age, gender, diabetes, blood pressure, cholesterol levels, smoking and risk of gastrointestinal bleeding-- before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. These recommendations do not apply to people who have already had a heart attack or stroke.
• The USPSTF recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage.
• The USPSTF recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.
• The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.
• The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.
Aspirin Improves Survival in Women with Stable Heart Disease, According to WHI Study
Compared to those who did not report taking aspirin, regular aspirin users had a 25 percent lower risk of death from cardiovascular disease and a 14 percent lower risk of death from any cause. There were no significant differences in death rates or other outcomes between women taking 81 mg of aspirin compared to those taking 325 mg.
Benefits of aspirin for treating osteoporosis
Aspirin reduces the risk of colorectal cancer.
Aspirin Better Heart Treatment for Men than Women
Aspirin therapy is a cornerstone in managing heart disease because it inhibits blood clotting. Aspirin therapy can reduce the risk of a nonfatal heart attack or stroke by about 23 percent, and an estimated 20 million men and women take a low dose of aspirin (81-325 mg daily) to control heart disease.
Aspirin Fights Cancer
A daily dose of adult-strength aspirin may modestly reduce cancer risk in populations with high rates of colorectal, prostate, and breast cancer if taken for at least five years.
Eric Jacobs, Ph.D., of the American Cancer Society in Atlanta, and colleagues looked for associations between long-term daily aspirin use (at least 325mg/day) and cancer incidence in a group of nearly 70,000 men and 76,000 women. Aspirin use was determined by a questionnaire.
During the 12 year follow-up, nearly 18,000 men and women in the study were diagnosed with cancer. The researchers found that daily use of adult-strength aspirin for at least five years was associated with an approximately 15 percent relative reduction in overall cancer risk, though the decrease was not statistically significant in women. Additionally, aspirin use was associated with a 20 percent reduced risk of prostate cancer and a 30 percent reduced risk of colorectal cancer in men and women, compared to people who didn't take aspirin. There was no effect on risk in other cancers examined—lung cancer, bladder cancer, melanoma, leukemia, non-Hodgkins lymphoma, pancreatic cancer, and kidney cancer. Aspirin use for less than five years was not associated with decreased cancer risk.
Long-term aspirin = reduced risk of dying in women
Women who reported using aspirin currently had a 25 percent lower risk of death from any cause than women who never used aspirin regularly. The association was stronger for death from cardiovascular disease (women who used aspirin had a 38 percent lower risk) than for death from cancer (women who used aspirin had a 12 percent lower risk).
"Use of aspirin for one to five years was associated with significant reductions in cardiovascular mortality," the authors write. "In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use. The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants and those with more cardiac risk factors."
Aspirin saves lives of cancer patients suffering heart attacks, despite fears of bleeding
Heart attack patients with low platelets who did not receive aspirin had a seven-day survival rate of 6 percent, compared with 90 percent survival in those who received aspirin. Dr. Durand notes that there were no severe bleeding complications in patients who used aspirin. Conversely, patients with low platelet counts who formed a blood clot and were not exposed to aspirin died.
The beneficial effect of aspirin also was seen in patients with normal platelet counts. Seven-day survival was 88 percent in aspirin-treated patients as compared to 45 percent in patients who did not receive aspirin, the researchers found.
Durand observed that these deaths rates are abnormally high. "In the non-cancer patient with acute coronary syndrome anywhere in the United States, an expected seven-day mortality is less than 1 percent," he says.
Low-dose aspirin offers lower chance of asthma
In a large, randomized, placebo-controlled study of 22,071 healthy male physicians, taking a low-dose of aspirin every other day lowered the risk of receiving an initial asthma diagnosis by 22 percent.