Fresh fears over daily dose of aspirin – experts reveal if you should take it
Aspirin is the most widely used drug in the world, but a study has highlighted fresh fears about its safety.
In the UK alone, 40% of over-60s take a low-dose daily aspirin to ward off heart attacks and strokes.
Many of these pills have been safely prescribed by a GP due to a patient’s high risk of cardiovascular disease.
However, there are a significant number of healthy people who self-prescribe – choosing to take a 75mg over-the-counter “mini” aspirin daily in the belief it is a good health insurance policy.
But a study by King’s College Hospital in London shows the risk of having major internal bleeding from regular use significantly outweighs the benefits for those with no history of heart disease.
“When we first discovered that aspirin could reduce heart attacks doctors started prescribing it – and people started taking it off their own backs – in large numbers. Not least because it’s cheap and easily available,” says Dr Judith Holmes, of Spire Parkway Hospital in Solihull, West Mids.
“But then we began to notice, as this study confirms, that it could cause serious internal bleeding in some people.
“This meant guidelines changed so we now only prescribe aspirin for people who have already had a heart attack or stroke or have a high risk of one.”
While aspirin can be dangerous to take every day without medical advice, it can still be a lifesaver for many – and you certainly shouldn’t stop taking it without talking to your GP.
Confused? Here’s the latest lowdown on aspirin…
How does aspirin benefit the heart?
It works by thinning your blood, making it less likely to form
artery-blocking clots. This is why aspirin can reduce your risk of heart attack or stroke.
Why did so many patients get told to take aspirin daily?
“In the past low-dose aspirin, which is very cheap, was frequently prescribed for even healthy people in middle age to reduce heart disease,” says Dr Holmes. “This was before we knew it could significantly increase your risk of internal bleeding.”
How does it trigger bleeding?
If you start to bleed in an internal area such as the stomach, your blood-clotting system won’t be as effective, which can be dangerous – even fatal. Estimates suggest that every year 5,000 people are admitted to hospital for serious internal bleeding caused by aspirin.
How have guidelines changed?
“When a decade ago a series of major studies started to reveal the risk of major bleeding, guidelines were changed to limit daily aspirin prescriptions to high-risk groups only,” explains Dr Holmes.
Who should take a daily aspirin?
“People who’ve had a heart attack or stroke – or who are at high risk of having one,” says Dr Holmes. For example, people who’ve had heart surgery or have chest pain (angina) caused by heart disease.”
Research shows a daily aspirin for these groups will help prevent around 20% of potential recurrent heart attacks and strokes.
“For anyone in this category, the reduced risk of a life-threatening heart attack far outweighs the risk of any side effects,” says Dr Holmes.
What about people with diabetes?
The study found the picture was more complicated for patients with diabetes, who are at higher risk of heart disease and who are often prescribed aspirin. Among these patients, the risk of a heart attack or stroke fell by 11% – while the risk of bleeding went up 30%.
According to study leader Dr Sean Zheng: “This shows that while cardiovascular events may be reduced in these patients, these benefits are matched by an increased risk of major bleeding.”
Dr Holmes’s advice is: “Don’t stop taking aspirin if you’re on it – talk it over with your GP so you can weigh up the pros and cons.”
Should I take aspirin to prevent cancer?
In 2016 a major study by Harvard University in the US found that taking just a quarter of an aspirin tablet a day could slash your risk of bowel cancer by a fifth.
It also found middle-aged people who regularly took the painkillers were less likely to be diagnosed with cancer of any kind – and other studies have found similar results.
While these initial findings are very exciting, according to Cancer Research UK, we’re not yet at the stage of prescribing aspirin for cancer prevention.
The charity says although some evidence shows aspirin may help to prevent certain cancers, this doesn’t mean everyone should start taking it until more research is done.
Are there any other dangers with taking aspirin?
Aspirin can also damage the stomach lining and cause ulcers, as it can reduce the amount of mucus protecting the stomach walls, allowing stomach acid to eat away at the lining.
Can drugs prevent this?
Patients who have to take higher doses of aspirin for chronic pain are often given drugs known as proton pump inhibitors (PPIs) to protect the stomach lining from acid.
One study by Oxford University suggested that anyone prescribed even a low-dose daily aspirin long-term could benefit from also being prescribed a PPI, as it could reduce bleeding risks by up to 90%.
The most commonly used PPI is omeprazole, which works by cutting stomach acid production.
However, it’s been linked with a higher risk of dangerous stomach bugs and of the bone-thinning condition osteoporosis, as it inhibits the stomach’s absorption of calcium.
If I do need a daily aspirin, when should I take it?
Because it can irritate the lining of the stomach, it’s better taken with or straight after food to minimise irritation and reduce your risk of bleeding.
“If you’re taking aspirin long-term, make sure you’re having at least twice-yearly reviews with your GP,” advises Dr Holmes.
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