Routine aspirin 'may cause harm'

Healthy people who take aspirin to prevent a heart attack or stroke could be doing more harm than good, warn researchers.

An analysis of more than 100,000 patients, published in Archives of Internal Medicine, concluded the risk of internal bleeding was too high.

The UK-led study said only people with a history of heart problems or stroke should take the tablets.

Experts said any decision should be made with a doctor.

Aspirin helps people who have had a heart attack or stroke. It prevents blood clots from forming by preventing cells, known as platelets, from sticking together. By reducing the number of clots formed, the tablets reduce the risk of another heart attack or stroke.

There have also been suggestions that the drug can prevent some cancers, however, the drug is known to increase the chance of internal bleeding, including bleeds on the brain.

The discussion has been whether at-risk or even healthy people should also take aspirin.

Official guidelines were issued in 2005 by the Joint British Societies, which includes the British Cardiac Society, British Hypertension Society and The Stroke Association. It recommended 75 mg of aspirin a day for high risk patients over the age of 50. The Drugs and Therapeutics Bulletin said in 2008 that preventative aspirin should be abandoned unless there was already evidence of cardiovascular disease.

Good or bad?

Researchers analysed data from nine trials, from a total of 102,621 patients.

They said that while there was a 20% reduction in non-fatal heart attacks in people taking aspirin, there was no reduction in deaths from heart attack, stroke or cancer.

Meanwhile the risk of potentially life threatening internal bleeding increased by 30%.Prof Kausik Ray, from St George's, University of London, told the BBC: "If you treat 73 people for about six years you will get one of these non-trivial bleeds.

"If you treat about 160 people for the same period of time, you're preventing one heart attack that probably wouldn't have been fatal anyway.

"It suggests that the net benefit for aspirin is not there, it certainly doesn't prolong life. If you think about it the net benefit, actually there is net harm.

The study followed patients for an average of six years. An analysis led by Prof Peter Rothwell, from Oxford University, suggested that regularly taking aspirin reduced the risk of a series of cancers, when patients were followed for much longer.

Prof Rothwell said the new study was "very nicely done, but I don't think it develops [the argument] much further".

He added: "It really just emphasises the need for a more detailed analysis of how risks change over time."

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said: "Aspirin can help reduce the risk of heart attack or stroke among those with known heart disease, and this group of people should continue to take aspirin as prescribed by their doctor.

"Our advice is that people who don't have symptomatic or diagnosed heart disease shouldn't take aspirin because the risk of internal bleeding may outweigh the benefits.

"If you're taking prescribed aspirin and have any concerns, don't simply stop taking it. Always talk to your doctor first."

Sotiris Antoniou, from the Royal Pharmaceutical Society, said: "People who buy aspirin should consult with their pharmacist to make sure that it is appropriate for them based on their individual likelihood of having a heart attack or stroke and their likelihood of experiencing a side effect such as stomach ulceration.

"If you are already taking aspirin, don't simply stop taking it, speak to the pharmacist about your individual circumstances."

Daily aspirin 'blocks bowel cancer'

Does and aspirin a day keep the cancer surgeon away?

A daily dose of aspirin should be given to people at high risk of bowel cancer, say scientists.

Two pills a day for two years reduced the incidence of bowel cancer by 63% in a group of 861 at-risk patients, a study reported in The Lancet said.
Newcastle University's Prof Sir John Burn, who led the study, said the evidence "seems overwhelmingly strong".
Other experts said the findings added to a growing body of proof that aspirin could be used in the fight on cancer.
The study was conducted on 861 patients with Lynch syndrome, which affects one in every 1,000 people.
They struggle to detect and repair damaged DNA which means they are more likely to develop a range of cancers including those of the bowel, womb and stomach.
'Good deal'
When looking at all patients in the trial, those in the group given 600 milligrams of aspirin every day developed 19 tumours compared to 34 tumours in the other "control" group, a reduction of 44%.

“Start Quote

People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition”

End Quote Prof Sir John Burn Newcastle University

When the researchers looked at just those patients who took the medication for at least two years the reduction was 63%.

There was also an effect on other cancers linked to Lynch syndrome, which fell by half in the treatment group.
Prof Sir John Burn, from Newcastle University, said there were 30,000 adults in the UK with Lynch syndrome.
If all were given the treatment he said it would prevent 10,000 cancers over 30 years and he speculated that this could possibly prevent 1,000 deaths from the disease.
However, there would also be side effects.
"If we can prevent 10,000 cancers in return for 1,000 ulcers and 100 strokes, in most people's minds that's a good deal," he said.
"People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition."
Aspirin is already well known to reduce the risk of heart attack and stroke in high risk patients.

Audrey Francis: walking time bomb

Audrey Francis describes herself as "a bit of a walking time bomb".
There is a history of cancer in her family and she has been diagnosed with Lynch syndrome.
Seventeen years ago she had a hysterectomy. That was when doctors discovered she had not one but two cancers - in the womb and the ovaries.
Tests showed she had a chunk of DNA missing which was causing the cancers: "I actually had the inability to stop the cancers developing," she said.
She took part in the trial and has since decided to self medicate with aspirin: "I've got my fingers crossed and I'm hoping it'll do the trick for me."

Other studies over the past two decades have suggested the pain killer reduced cancer risk, but this was the first randomised control trial, specifically for aspirin in cancer, to prove it.

In 2010, a study suggested patients given aspirin had a 25% lower risk of death during that trial.
Prof Peter Rothwell, from Oxford University, who conducted that study said the latest research "certainly helps to build a consistent picture, all pointing in the same direction that there is a link with cancer".
Cancer Research UK's Prof Chris Paraskeva said: "This adds to the growing body of evidence showing the importance of aspirin, and aspirin-like drugs, in the fight against cancer."
'Balanced argument'
One of the questions asked by the research into aspirin was whether healthy people with no family risks should take the drug.
The lower the risk of heart attack or cancer, the lower the benefit of taking aspirin, yet there are still potentially deadly side effects.
Sir John said that it was a "finely balanced argument" and that he decided the risks were worth it for him.
"I think where we're headed for is people that are in their 50s and 60s would look very seriously at adding a low dose aspirin to their daily routine because it's giving protection against cancer, heart attack and stroke.
"But if they do that they've got to have their eyes wide open. They will increase their risk of ulcers and gastrointestinal bleeds and very rarely they will have a stroke caused by the aspirin."