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An Aspirin a Day ... or Not?

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

Studies reviewed by the U.S. Preventive Services Task Force have shown that daily or every-other-day aspirin therapy reduced the risk of coronary heart disease by 28%in persons who had never had a heart attack or stroke, but who were considered high-risk individuals.

It's also pretty easy to identify those individuals who, in all probability, don't need to take aspirin on a daily basis, Fendrick says. Healthy people in their 20s and 30s, for example, with no cardiac risk factors and no major risk factors for developing the other diseases aspirin can prevent, such as certain cancers, should consider the risks of aspirin therapy to outweigh the benefits.

But then there's a large group of people that fall into the middle category -- the "probably-should-take" group. For these people, individuals with a strong family history of colon cancer, for example, or dementia, balancing aspirin's potential benefits against its well-documented risks can be a very complicated equation. "The benefits of aspirin for preventing colon cancer, dementia, and heart attacks need to be carefully weighed by a medical professional against the potential for serious complications," says Dr. Fendrick.

The FDA also provides a fact sheet on deciding whether or not daily aspirin therapy is right for you (it's specific to heart disease) on its web site.

More Isn't Always Better

If you and your doctor decide you should be taking aspirin daily, the next question is, "How much?" In the land of the super-size, is it any wonder that we think that if one pill is good, two must be better, and if 100 milligrams may help prevent cancer, 200 or 300 milligrams must have twice or three times as much cancer-busting power? Stop right there. Medications don't work that way, and especially in the case of aspirin and other NSAIDs, a little goes a long way.

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