Take two
Once seen as a wonder drug, aspirin now raises fears of side effects
Is aspirin a lifesaver or a latent killer? The common pill, found in most everyone's medicine cabinet, packs a lot of controversy. No one disputes its potential for your heart: An aspirin a day can cut your chance of having a first heart attack by about a third. And taking the drug during a heart attack can reduce the chance of death. Aspirin works because it thins your blood, which helps to prevent clots.
But regular aspirin use comes with possible side effects, such as bleeding in the gastrointestinal tract and brain, and pancreatic cancer. What doctors and researchers can't agree on is if otherwise-healthy people at risk of a heart attack should take the drug -- if its heart-protective benefits offset its potential side effects.
These side effects are usually not a concern to people who take aspirin occasionally to fight a headache, ease pain and swelling, or reduce a fever, experts say. But to stave off a heart attack, you need to take it every day or every other day, at doses ranging from 81 milligrams (the amount in a baby aspirin) to 325 mg (a standard-size aspirin) and sometimes more. Because higher doses bring a higher chance of side effects without any extra benefits, most doctors -- and the American Heart Association -- recommend taking no more than one regular aspirin a day, and many believe a baby aspirin is enough.
Despite these side effects, researchers and doctors generally agree that people who've already had a heart attack should take an aspirin a day, as long as they've checked with their doctors to make sure they're not allergic to aspirin or prone to bleeding problems. People having a heart attack are also advised to take an aspirin during the attack to reduce the chance of death. And the experts say that healthy people at low risk for a heart attack -- because of their low cholesterol levels or young age, among other factors -- should skip the drug.
Yet such clear answers aren't available for those people in the gray area -- people who are otherwise healthy and haven't had a heart attack but who are at moderate to high risk for one because they weigh too much, have elevated blood pressure or cholesterol, smoke, or are otherwise prone to heart problems. These people need to weigh the benefits and risks of aspirin use with their doctors.
The Food and Drug Administration soon may offer some guidance. On Dec. 8, an advisory committee at the agency held a public meeting to discuss whether its aspirin recommendations to physicians should be expanded to include giving a daily dose to those people in the "gray area" who haven't had a heart attack but are at risk for one. (Currently, the FDA recommends aspirin only for people who've already had a heart attack or certain other cardiovascular conditions.)
While some researchers and aspirin-maker Bayer HealthCare spoke in favor of the change, the advisory committee voted against it. Now the FDA will consider the committee's finding and the public's input before it makes a final decision.
Dr. Charles H. Hennekens, who as a researcher in Boston in 1988 was the first to demonstrate that aspirin could lower the chance of a first heart attack, said he believes more at-risk people should start the drug. But he also worries about well-intentioned but reckless use of aspirin by people who don't really need it.
"I remain concerned because aspirin is an over-the-counter drug, and I think the best thing to do if you think you're a candidate is to talk to your health-care provider," said Hennekens, now a professor of medicine and epidemiology and public health at the University of Miami School of Medicine. "There is overall about a 60 percent higher risk of bleeding among aspirin-takers. Make sure that your benefits will outweigh the risk."
Dr. Eva Schernhammer knows firsthand how controversial aspirin can be. A cancer epidemiologist at Harvard Medical School and Brigham and Women's Hospital, Schernhammer led the team that found that women who take an aspirin a day have an increased risk of pancreatic cancer. When the news broke in late October, anxious women started calling her office, wondering what to do.
"My standpoint was always, when a patient would ask me: `Continue taking aspirin at the moment.' Because I strongly believe that the benefits of aspirin do outweigh whatever risks we know for now."
But she also worries that consumers might be hearing only half the message on aspirin. "You shouldn't take an aspirin just because you think it might be good for you," she said. "You should only take it if there's a reason, say a family history of cardiovascular disease or some risk factors for cardiovascular disease."
She emphasized that her pancreatic findings are only preliminary, and even if other studies confirm the elevated risk, pancreatic cancer is still quite rare. Cardiovascular disease, on the other hand, is the nation's No. 1 killer.
Winchester resident Laura Bradford, 56, takes 81 mg of aspirin every other day in hopes of staving off a heart attack. She believes her high cholesterol, which she's treating with statin medication, puts her at risk of an attack. So far, nothing she's learned about aspirin has convinced her to give it up.
But, she said, "If there was a study showing `Wait a minute, it's not what it's cracked up to be,' I would stop. . . . I'm trying to walk that line of safety vs. benefits." Bradford hasn't told her doctor she's taking aspirin, but she feels confident she knows enough about the drug; she's a former cardiac nurse and she follows aspirin research.
There are, of course, alternatives to aspirin -- a healthy diet and a regimen of moderate exercise and stress relief. Some physicians believe these approaches deserve the attention that's now paid to aspirin.
"When you take large numbers of people and you put them on a drug, whatever drug, even one that's been around as long as aspirin, you may find unanticipated consequences," said Dr. Dean Ornish, a clinical professor of medicine at the University of California in San Francisco. "The history of medicine is replete with examples like that."
Ornish, who among other books wrote
Ornish said he would recommend aspirin only when a person is doggedly unwilling to make any lifestyle changes.
A few doctors simply refuse to recommend the drug at all. Dr. Joseph Mercola, an osteopathic physician and medical director of the Optimal Wellness Center in Schaumburg, Ill., used to suggest one baby aspirin three times a week to patients at risk of heart disease.
A couple of years ago, after seeing one too many studies that warned of the dangers of regular aspirin use, he did an about-face. Now he won't recommend aspirin to anyone -- even patients who've already had a heart attack -- and is speaking out about his doubts about the drug. "It's not like people have an aspirin-deficiency syndrome."
