Study Casts Doubt on Low-Dose Aspirin for Women Under 65

Although low-dose aspirin may curb the risks of heart disease and colon cancer, the downsides appear outweigh the benefits for many women, a new large study suggests.

For women younger than 65, researchers found taking low-dose aspirin for years lowered the risks of heart attack, stroke and colon cancer by a small amount. But they also found that the benefit was countered by an increase in the risk of major gastrointestinal bleeding – serious enough to land a woman in the hospital. For women 65 and over aspirin boosted their risk of bleeding too – but the benefits against heart disease and colon cancer were bigger, researchers reported. The study appeared online on December 4th in the journal Heart.

Many people have heard that low-dose aspirin is good for the heart, and may feel like it’s a good idea to take some every day. But the reality is much more complicated, said Dr. John Erwin, a cardiologist at Scott & White Memorial Hospital in Temple, Texas.

“There’s no question that aspirin can be a lifesaver for people who’ve already had a heart attack,” said Erwin, who was not involved in the study. For those people, he explained, a daily aspirin – if recommended by a doctor – can help prevent a repeat heart attack or other cardiovascular complications.

When it comes to preventing a first-time heart attack, or any other disease – what doctors call “primary prevention” it’s still unclear which people stand to gain a benefit that will outweigh the risks of aspirin.
The American Cancer Society advises people against popping the drug solely to ward off cancer. Similarly, the American Heart Association recommends only that people at “high risk” of heart attack consider taking aspirin. Meanwhile, the US Food and Drug Administration (FDA) recently came out against using aspirin for preventing first-time heart attacks and strokes – citing the potential harms.

The findings are based on a clinical trial of nearly 28,000 women, average age of 55 at the start of the study. They were randomly assigned to take low-dose (100 mg) aspirin or placebo pills every other day.



Over the next 15 years, about 11% of the women developed cancer, suffered a heart attack or stoke, or died of cardiovascular causes. Women who’d taken aspirin saw a small decrease in their odds of cardiovascular trouble or colon cancer – but at the expense of an increase in the risk of gastrointestinal bleeding, the researchers found.

MY TAKE:
This study just reinforces previous studies indicating that aspirin should not be used for “primary prevention”. However, every day in my practice, I see patients doing just that.
Aspirin is a potent blood thinner and vasodilator, offering some protection from clots that could potentially create heart attacks or strokes. However, it is also a Cox 2 inhibitor, blocking all three prostaglandin (PG) pathways. Blocking the PG2 pathway reduces inflammation and pain, the original use for aspirin. However, blocking the PG1 and PG3 pathways has the reverse effect of increasing inflammation. It also impairs hormone production and cell membrane production.

The most obvious effect from daily aspirin use is an inability to replace the lining of the digestive tract resulting in GI bleeds. The second most common effect is liver failure and the third, ironically, is heart failure.

THE BOTTOM LINE:
There are much better ways to keep the blood flow moving – omega 3 fatty acids from fish and flax; and omega 6 fatty acids from olive oil, black current seed oil, and evening primrose oil. These foods are all used by the body to make those anti-inflammatory PG1’s and PG3’s. If you have not had that first heart attack, stay away from the aspirin.

Source: National Institutes of Health –Thursday, December 4, 2014