Aspirin is the oldest and most common of a family of non-steroidal anti-inflammatory drugs (NSAID), which also includes Motrin, Anaprox, Lodine, Meclomin, Nalfon, Naprosin, Ponstel, Relafen, Toradol, Tolectin, Indocin, Advil, ibuprofen, etc. It was invented a century ago to fight arthritis, and is proven every few years to combat yet another disease. All the NSAIDs fight pain and inflammation, but aspirin alone also helps cure or prevent arthritis, heart attacks, deaths from heart attack if taken quickly, other cardiovascular diseases and symptoms, brain attacks (stroke), breast and colon and prostate cancer, and maybe pancreatic cancer and Alzheimer's. It's dirt cheap (anything over a penny is a waste of money), and in rational doses is safe for most people. In every sense, it qualifies as a miracle drug. While NSAIDs kill 5-10,000 U.S. citizens annually, the proper use of aspirin alone could save 10,000 other lives and relieve much suffering in millions.
Let's examine both sides of the aspirin dilemma.
Bayer claimed in the 1920s that aspirin would not affect the heart. Fortunately, that was untrue. Aspirin has a dramatic, beneficial effect on the entire cardiovascular system. Of all the NSAIDs, only aspirin helps blood platelets slide over each other, helping to prevent blood clots, which block blood and oxygen flow to the heart (heart attacks) and the brain (brain attacks, aka stroke). It combats heart attacks better than some drug therapies costing thousands of dollars. No other pain reliever or fever-reducing drug has demonstrated aspirin's beneficial impact on cardiovascular health, probably because they have no effect on platelets. That anticoagulant effect is so pronounced we should stop taking it a week before surgery or our next bicycle tumble.
Given those benefits, should we all eat it like popcorn? Certainly not:
- Aspirin increases the risk of excessive bleeding, probably including one kind of stroke.
- Many large, sound studies established that long-term aspirin therapy, even lower-dosage or modified-release versions such as enteric-coated baby aspirin, even when taken with meals, is associated with a gastrointestinal (GI) hemorrhage risk in about one percent of patients treated for 28 months, up to three percent in patients over 60. It can irritate the stomach lining and cause heartburn, pain, nausea, vomiting, ultimately internal bleeding, ulcers, and holes in the stomach or intestines. 76,000 Americans are hospitalized annually with GI bleeding from NSAID use, and about 10% of them die from it. Both duration and dose affect GI impact, the former more so.
- Way before GI bleeding, the risks of esophageal stricture and subsequent necessity for dilation (ever swallow a baseball bat?) are very real.
- People who drink three or more alcoholic beverages a day are at increased risk of liver damage and stomach bleeding from most over-the-counter pain-killing drugs, including aspirin and Tylenol/acetaminophen.
- High doses of aspirin may cause temporary and usually reversible ringing in the ears and hearing loss.
- Two of every thousand people are allergic to aspirin, and may get swelling or asthma from it.
- It can cause a rare and serious brain and liver disorder called Reye's syndrome in children and teenagers.
- NSAIDs, including aspirin, can produce a number of temporary or permanent adverse effects on the kidneys and liver, especially with pre-existing liver disease, juvenile arthritis, or rheumatic fever.
- NSAIDs may also exacerbate hypertension or interfere with the effectiveness of blood pressure medications.
- Topical NSAIDs, which are rubbed on the skin to provide joint pain relief, produce little therapeutic benefit beyond placebo effect, yet have led to some increased risk of GI bleeding and kidney impairment.
- The long-term, heavy use of pain killers, especially those with caffeine or codeine, can exert direct toxic effects on kidney cells in people with kidney problems.
Oh, there's more ... much more ... on both sides of the argument.
Aspirin (and other NSAIDs) taken before exercise to ease pain during the exercise will help relieve some of the soreness during exercise and will not hinder strength, speed, coordination, or endurance. However, it is likely to delay recovery afterwards, it will not prevent soreness the day after, and exercising sore muscles increases your chances of injury. Continued use of NSAIDs delays healing of broken bones and can increase the rate of cartilage breakdown in osteoarthrititic joints. Stop taking pain medication for these problems as soon as you can do without them, to help the body heal.
Aspirin's proven ability to lower the risk of heart attack may be due to its anti-inflammatory properties. Recent studies suggest that inflammation plays a large role in hardening the arteries, and C-reactive protein, a marker for inflammation, is elevated in some patients with acute coronary events (e.g., heart attack or unstable angina). The simple, inexpensive test for C-reactive protein should be added to your tests for cholesterol and homocysteine-A.
In theory, the ACE inhibitors used to treat known heart disease should conflict with aspirin. In tests, however, patients at risk of cardiovascular events clearly benefited from therapy by combination of the two. (Vitamin E showed no benefit, helping even less than a placebo.)
Aspirin helps avert strokes and mini-strokes (transient ischemic attacks) caused by blockages in blood vessels of the brain and in minimizing damage when such strokes occur if taken within 48 hours after a stroke. However, aspirin may (studies conflict) also increase the risk of hemorrhagic stroke (bleeding into and around the brain), especially in women. You must consult a doctor to weigh your individual risks.
Ibuprofen (e.g., Motrin, Advil) blocks aspirin's cardiovascular benefits. Occasional ibuprofen several hours before a daily aspirin won't affect aspirin's long-term benefit, but if your ibuprofen use is frequent, ask your doctor to recommend a non-ibuprofen painkiller. Since ibuprofen blocks aspirin's cardiovascular benefit for only two hours, heart patients can probably take ibuprofen a few hours before or after aspirin.
Individuals at high risk of both cardiovascular events and NSAID-related GI damage may benefit from regular use of acid-reduction medication. Discuss with your doctor your personal risks and choices among gastroprotective medications such as Misoprostol (Cytotec), proton-pump inhibitors such as omeprazole (Prilosec), and histamine H2 receptor antagonists such as famotidine (Pepcid).
Who should not take aspirin regularly? Anyone who gets stomach irritation when taking it, is allergic to it, is taking blood thinners, has a hangover, gets recurrent ulcers or gout, has asthma or hearing loss or liver problems, is pregnant, is under 18, or has not been advised by their doctor, after examination, to take it. Celebrex and Vioxx, new forms of aspirin, relieve pain and inflammation with a much lower incidence of GI side effects, but do not offer the heart attack protection of low-dose aspirin. (Watch for a new form of aspirin called PolyAspirin( in a few years, which should overcome aspirin's side effects.)
Despite all those side effects, every one at significant risk of a heart attack or clot formation should consult a physician to determine whether daily aspirin's preventative cardiovascular benefits outweigh its threats. Probably five times more people, especially those with any personal or family history of heart disease, should be taking aspirin regularly. 5-10,000 heart attack deaths each year, and heart damage in thousands of other people, could be averted if victims chewed - not swallowed -- an aspirin at the first sign of the attack, certainly within 30 minutes of its onset. Uncomfortable pressure or pain in the center of the chest (sometimes along with lightheadedness, fainting, shortness of breath, nausea, or sweating) or a pain going to the shoulders, neck and arms are a good reason for a heart patient to chomp an aspirin.
If you have some condition that might be helped by regular NSAID doses (heart disease, arthritis, chronic pain of any kind), ask your physician these questions: What is the lowest dose I can take? Would I be better off with ibuprofen (e.g., Motrin) or acetaminophen (e.g., Tylenol) or another NSAID instead of aspirin? Am I at high risk for stomach bleeding? What are warning symptoms? Will any of my other prescription or over-the-counter medicines or herbs interact with this medicine? Do I really need another chemical in my body?
If, after the fog clears, you begin aspirin therapy, you can save the unnecessary extra expense of baby aspirin by using an inexpensive pill-cutter to halve or quarter generic aspirin tablets. Take a whole regular aspirin twice a month instead of that day's 1/4 aspirin to prevent clots.
Just because aspirin is more available than popcorn doesn't mean it can be taken as freely. It is most definitely a medicine, a chemical, and a drug, and must be considered and treated as such. If you use it fast enough to finish a small bottle before it goes bad (smells like vinegar), your doctor should be in the loop.