Aspirin and the prevention of cardiovascular disease and colon cancer

Aspirin, or closely related chemical compounds, has been used to treat fever, pain and inflammation for thousands of years, dating back to ancient Egypt and earlier. The modern use of aspirin began in the 1890s when the German chemical company Bayer produced acetyl salicylic acid, sold under the trademarked name of Aspirin.

For much of the 20th century, generic aspirin was the principal anti-inflammatory medicine in the average American’s drug cabinet, used for the treatment of conditions ranging from minor colds and fever to severe systemic illnesses such as rheumatoid arthritis. While effective, aspirin has many potential side effects, including promoting gastrointestinal bleeding, hemorrhagic stroke and liver and kidney damage. During the latter years of the century, aspirin’s use declined significantly, replaced by safer and oftentimes more effective drugs such as acetaminophen (Tylenol) or ibuprofen (Motrin).

Beginning in the 1980s, it became generally recognized that regular aspirin use can play a role in the prevention of heart attacks or strokes, causing a resurgence in aspirin sales and use by the general public. Over the last decade, further evidence has emerged that aspirin may play a positive role in the prevention of colorectal cancer. As a result, many Americans of all ages have begun a self-prescribed regimen of daily aspirin, often without firm knowledge of the potential benefits and risks.

There has been much confusion as to who should take regular aspirin and who should not. If aspirin was brought on the market today, it is likely that it would be available only by prescription. While potentially lifesaving in some situations, the risks of regular use may greatly outweigh an individual’s benefit based on age, gender, concomitant medicine use and other co-existing health conditions. Equally confusing, the medical community’s recommendations for aspirin therapy have evolved and changed as more scientific data have become available.

Fortunately, there is a reliable institution whose purpose is to give advice and guidelines for such issues based on objective medical evidence. This is the U.S. Preventive Services Task Force, created in 1984 “to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.” For many in the health community, it has become the gold standard when dispensing such advice.

The group divides its recommendations into three broad categories. Preventive therapy or services that have been shown to have a positive benefit are rated “A” (the best) to “C” (the weakest). For those services that should be discouraged, a “D” rating is given. Those where there is insufficient data to make a recommendation one way or the other receive an “I” rating. Surprisingly, regular aspirin use for the prevention of cardiovascular disease and colorectal cancer is advised only for a narrow range of patients based on age and other conditions.

For adults between the ages of 50-59, who (1) have risk factors for cardiovascular disease, (2) are not at increased risk of bleeding, (3) have a life expectancy of 10 years or more, and (4) are willing to take daily low dose (81mg) aspirin daily for 10 years, the task force recommends its use with a “B” rating. For those 60-69 years old with the same characteristics, the group gives a “C” rating but with the warning that regular aspirin use is for those “who place a higher value on the potential benefits than the potential harm.” The data do not support preventive use of aspirin for those younger than 50 or older than 70.

The bottom line: Check with your personal physician or see the task force website at www.uspreventiveservicestaskforce.org.

This story was originally published January 20, 2017 at 12:54 PM with the headline "Aspirin and the prevention of cardiovascular disease and colon cancer."