Perhaps the most widely used drug in human history, aspirin has received terrible press in the last few months. Prescribed often by doctors since it was first invented in the 1890s, it has some remarkable properties. It is anti-inflammatory, which helps people with arthritis. It is given to patients after they have heart attacks or strokes or after having heart procedures such as stents or bypass surgery to prevent another cardiac event. It relieves pain, lowers fever, and can make blood less sticky. Studies have even linked aspirin to a decreased chance of getting colon cancer.
So, why the bad rap? Recent large-scale trials, known as ARRIVE, ASCEND, and ASPREE (names more suggestive of science-fiction movies than clinical trials), have suggested that taking aspirin might do more harm than good.
All these trials looked at low-dose aspirin (100 mg per day) given to people without known cardiac disease, compared aspirin directly with a placebo pill, and had the goal of finding out whether taking daily aspirin prevented problems in the future. ARRIVE found aspirin had no benefit in preventing heart problems but led to a higher risk of bleeding. ASPREE gave aspirin to the elderly, who were more than 70 years old when they started the five-year trial. Not only did aspirin not prolong life compared with a placebo, it unexpectedly was associated with a higher risk of dying from cancer. ASCEND looked at people with diabetes and found a 12 percent decrease in the rate of vascular events, but at the cost of a 29 percent increase in serious bleeding events.
So clearly, there may be a problem with this low-cost miracle drug. How can the new information be reconciled with the tradition of taking aspirin to help almost everything? Following are my suggestions, based on available studies, about who should take it and who should not: