By Ross Walker

I’m often asked by my patients whether they should be taking a daily dose of baby aspirin i.e. 100mg, to prevent heart disease. Unfortunately, there is no definitive answer to this very important and very intelligent question. When one study is released supporting the benefits of daily aspirin, there is a rush to pharmacies with people wanting to ensure they receive their daily dose of this little miracle. Then, a further study is released refuting the benefits, leading to everyone who hears of the study immediately stopping this therapy.

As with most answers in medicine, the true approach should be somewhere in the middle. For many years, it has been well established that taking aspirin, around 100mg daily, may reduce your risk for cardiovascular disease and in particular heart attack by around 25%, taken from trials in high-risk patients. Over the past decade, there have been a number of studies also suggesting reduction in many common cancers with the daily ingestion of aspirin. Some studies have even suggested up to a 50% reduction in colon cancer, purely by taking aspirin on a daily basis.

So, what’s the downside? Once we all reach 50, why don’t we all start ingesting this little pill? The problem with making this across-the-board recommendation is that some people do experience significant problems, in particular bleeding and reflux, by taking aspirin. Aspirin is an highly effective blood thinner, even in low doses, working by reducing the stickiness of blood cells known as platelets which are intricately involved in the formation of clots, thus the benefits in reducing heart disease. Possibly because of their anti-inflammatory effects but also due to a direct effect on cancer cell growth and spread, it does appear that there is some cancer preventive benefits with the use of prophylactic aspirin. But, aspirin has been shown to commonly irritate the lining of the stomach and when this is combined with an increased tendency to bleeding, in some cases, may be a recipe for disaster precipitating significant gastrointestinal bleeding.

I often quote the personal case of my mother who, 10 years ago, unbeknownst to her son started taking aspirin and within six months had wiped out the lining of her stomach and lost half her blood volume. When I asked my mother why she was taking aspirin, she remarked that she read it was good for the heart. I then reminded her that I had been a cardiologist for 25 years and she could’ve discussed this with me.

The regular ingestion of aspirin is also associated with reflux oesophagitis in around 5 to 10% of cases. It is, however, my opinion that all people with established heart disease should be taking aspirin unless they have significant reflux, gastric irritation or a history of bleeding.

A recent analysis from the University of Southern California has estimated that if all Americans aged 50 to 80 took daily low dose aspirin, 11 cases of heart disease and four cases of cancer would be prevented for every thousand people. In pure financial terms, it was suggested that this would save the US economy just under $700 billion dollars over a 20-year period.

So with all of this evidence, it would be my suggestion that if you have strong risk factors for heart disease or cancer, our two common killers, then taking daily low dose aspirin will probably give you additional health benefits. If, however, you have a prior personal history of significant bleeding, typically from the gastrointestinal tract or possibly even a prior history of a brain bleed, easy bruising, or you are prone to reflux oesophagitis, then it is probably better to avoid aspirin.

As with all my suggestions in these articles, it is vital you discuss these issues with your general practitioner before making a medical decision on your own.