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An Aspirin a Day ... or Not?

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

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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.

"Low-dose aspirin, a 'baby aspirin' dose of 81 milligrams, is safer and just as effective as the standard adult dose of 325 milligrams," says Dr. Fendrick. "When a drug has serious side effects, as aspirin does, you want to give the lowest effective dose. We know now that you don't need 325 milligrams in a great majority of circumstances."

A patient who's having a heart attack right now, for example, should be given a full 325-milligram dose of aspirin, but the person at elevated risk for a heart attack, who's taking daily aspirin as a preventive measure, should stick with the smaller 81-milligram dose.

Taking low-dose aspirin isn't the only way to maximize the drug's benefits while minimizing its dangers. For people at increased risk of gastrointestinal complications, Fendrick recommends combining any aspirin therapy with a prescribed proton pump inhibitor (PPI) such as Prevacid, Prilosec, or Nexium.

In a study of people with prior gastrointestinal bleeding, whose doctors felt their chance of having a heart attack was high enough to warrant aspirin therapy despite its gastrointestinal risks, a standard dose of Prevacid reduced their risk of further bleeding by about eightfold. Enteric-coated aspirin or buffered aspirin do not appear to have a reduced risk of bleeding or other adverse events in the stomach.

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