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An Aspirin a Day ... or Not?

Aspirin's protective powers may now guard against cancer, too.

WebMD Feature

We've long known that aspirin reduces the risk of heart attacks and strokes while increasing your chances of surviving them. But now this household drug may protect you in other ways, too.

Newer evidence indicates that aspirin can also reduce the risk of cancer of the colon, esophagus, stomach, rectum, and prostate. And most recently, the humble aspirin has offered the tantalizing possibility that it may help protect against Alzheimer's disease. With all of these potential benefits, why aren't we dumping aspirin in the water as we do with fluoride?

"Aspirin is the one drug I would take to a desert island with me," says Mark Fendrick, MD, an associate professor of internal medicine at the University of Michigan Medical School in Ann Arbor. "It costs two cents a day and its benefits are amazing. And if it had no side effects at all, we could give it to everybody." But Dr. Fendrick worries that the ever-growing list of diseases and disorders that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) seem to combat drowns out information about the risks of this "wonder" drug.

"When you take aspirin, the level of stomach protection is decreased and you're more likely to bleed. Thus, people who take aspirin regularly -- even in a buffered or coated form -- will have roughly double the likelihood of having a perforated ulcer or bleeding in the GI tract," explains Fendrick. "Relatively little attention is paid to this problem that kills more people in the U.S. each year than asthma or cervical cancer. What we need to do is focus less attention on finding more things that make aspirin look good, we have plenty of those, and think more about focusing on how to minimize risk."

So how do you decide whether or not a regular, preventive dose of aspirin is right for you? And if it is, how do you lower the risk of side effects? There's no simple formula, unfortunately. "When you're deciding whether someone should take blood pressure medication or diabetes medication, there are clear cutoffs. In the case of aspirin, the decision is multifactorial and requires a lot of thought," Fendrick tells WebMD.

Those patients most in need of daily aspirin therapy are easy to identify. If you have a documented personal or family history of heart disease -- including heart attacks, stokes, or angina; if you have diabetes; or if you have multiple risks for the development of heart disease such as have high blood pressure, high cholesterol, or are a smoker, you should most likely take a daily dose of aspirin (but always consult with your physician first). Although the optimal dose of aspirin in prevention of future heart disease is still unclear, doses of 75 milligrams, 100 milligrams, or 325 milligrams have been found to be equally effective.

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