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Should You Take Aspirin or Shun the Wonder Drug?

It's surprising to learn that even after a century aspirin remains highly controversial. Should people take aspirin to prevent heart attacks and cancer?
Single baby aspirin may be helpful to cardiac health

Aspirin is one of our oldest medications. The Bayer company first began marketing aspirin in 1899. But Chinese healers were using willow bark, the precursor to modern-day aspirin, as far back as 500 B.C. It is surprising, then, that there is still so much controversy over aspirin 120 years after it became available. Doctors debate whether patients should take aspirin or avoid the “wonder” drug.

Aspirin for the Heart? A Very Slow Start!

It all began with a chance observation by a general practitioner in Glendale, California. Shortly after the introduction of aspirin-containing chewing gum (Aspergum), Dr. Lawrence Craven began handing out packages of this chewing gum to patients who had undergone tonsillectomies.

He instructed them to chew one stick of gum (containing 226.5 mg or 3.5 grains of aspirin):

“one half hour before each meal and at bedtime in order to enable them to eat and sleep well.”
(Annals of Western Medicine, Feb. 1950)

Dr. Craven’s regimen (just under three regular-strength tablets per day) did appear to provide some pain relief, but an unexpected problem occurred:

“… several of my patients had serious postoperative hemorrhages which were difficult to control. The bleeding was sometimes so severe that hospitalization was necessary. In each instance the laboratory reported a prolonged coagulation time.”

A Chance Discovery and an Explanation:

After checking with these patients, Dr. Craven found that they had been so pleased with the Aspergum that they had purchased additional packets and were consuming extra sticks daily. It could have ended there, but Dr. Craven reviewed the medical literature of the time and discovered that salicylates had a powerful anticoagulant effect.

He went on to speculate that

“…if further study confirms the impression that acetylsalicylic acid [aspirin] prolongs coagulation time, it would appear that the drug might be of value as a preventative of vascular thrombotic conditions, including coronary thrombosis [heart attack].”

Dr. Craven soon put this theory into practice. In 1950 he reported that:

“…during the past two years, I have advised all of my male patients between the ages of 40 and 65 to take 10 to 30 grains [two to six regular–strength tablets] of aspirin daily as a possible preventive of coronary thrombosis. More than 400 have done so, and of these, none has suffered a coronary thrombosis.”

Encouraging Patients to Take Aspirin:

Over the next six years Dr. Craven continued his research with smaller aspirin doses, encouraging friends and patients to take one tablet daily. He reported that this regimen could prevent heart attacks in otherwise healthy men or could prevent recurrences in those who had already suffered a coronary thrombosis.

Dr. Craven reported that:

“…approximately 8,000 men have adopted the regime calling for from 5 to 10 grains [one to two tablets] of aspirin daily, with a surprising result. Not a single case of detectable coronary or cerebral thrombosis [clotting stroke] has occurred among patients who faithfully have adhered to this regime.”
(Mississippi Valley Medical Journal, Sept. 1956)

Ignored and Forgotten:

Dr. Lawrence Craven’s observations were almost completely ignored by the medical establishment. It wasn’t until the 1970s that large–scale aspirin studies began reappearing. In 1989, the American College of Chest Physicians recommended that people at risk of coronary artery disease should take aspirin daily (one regular-strength tablet).

Should Healthy People Take Aspirin?

For decades, doctors recommended low-dose daily aspirin to prevent heart attacks and strokes in otherwise healthy people. That was largely because of the Physicians’ Health Study published in the New England Journal of Medicine (July 20, 1989)

In this randomized controlled trial, healthy male physicians took regular aspirin or placebo every other day. After five years, the aspirin takers had experienced 44 percent fewer heart attacks.

A study published two years later (Annals of Internal Medicine, May 15,1991) on a subgroup of men with chest pain (stable angina) concluded that the risk of a heart attack was 87 percent lower if they took aspirin every other day. Such data eventually convinced a lot of doctors to prescribe aspirin to prevent heart attacks in healthy people.

The Dark Side of Aspirin:

Remember that Dr. Lawrence Craven started studying aspirin because it caused bleeding in patients who chewed too much Aspergum after surgery. Since then, we have learned that people who take aspirin regularly can indeed suffer dangerous hemorrhages. Recent research has suggested that nearly as many healthy people experience harm as are protected from heart attacks when they take aspirin.

That has led the American Heart Association to recommend that aspirin be reserved for people at high risk of heart attacks or clotting strokes. New reports about aspirin studies have scared a lot of people. For example, one headline read:

“Taking a daily aspirin causes the risk of major bleeding to increase by 43 per cent, study claims.”

That sounds terrifying. However, the actual rate of major bleeds was 2.3 in 1,000 people taking aspirin and 1.6 in 1,000 people not taking aspirin. That means an extra five people per 10,000 would have a major bleed if they take aspirin (JAMA, Jan. 23, 2019). That is worrisome, but it sounds a lot less foreboding than 43%.

Heart attack prevention is not the only potential benefit of aspirin, however. Researchers have been looking at its anticancer activity for decades.

Should People Take Aspirin Against Cancer?

The most recent research was published in JAMA Network Open (Dec. 2, 2019).  Investigators tracked 146,152 individuals for an average of 12.5 years. These were individuals who had been diagnosed with colorectal, lung, prostate or ovarian cancer.

People who took aspirin three or more times a week were less likely to die during the study from cancer in general and colorectal cancer in particular. All-cause mortality was also lower among aspirin takers.

The article concludes:

“In this cohort study, we found a significant association of aspirin use with reduced all-cause, any cancer, GI cancer, and CRC [colorectal cancer] mortality among individuals 65 years and older in the PLCO [Prostate, Lung, Colorectal, and Ovarian] Cancer Screening Trial.”

The Pros and Cons of Aspirin:

Like all drugs, aspirin has both benefits and risks. Because it is old and only costs pennies a dose, it may not get the respect it deserves.

However, there are relatively few drugs that have been proven to prevent cancer or prolong life after metastases, especially at such a low price. After more than 120 years, perhaps we should reconsider the value of aspirin and resurrect the old Bayer aspirin tagline:

“The wonder drug that works wonders.”

No one should ever take aspirin on a regular basis without first checking with a physician. Some people are at such a high risk of bleeding that aspirin is absolutely inappropriate.

If you take aspirin, you should always be monitored regularly by a physician. Many medications can interact with aspirin. That would be another reason you should not take aspirin if you are on a medicine that is incompatible with ASA. A pharmacist can check for drug interactions.

Learn more about aspirin as an anticoagulant at this link:

Is Aspirin Cost-Effective Blood Clot Prevention?

Deciding whether the benefits outweigh the risks is complicated. Here is an article that will help you and your doctor make that decision:

How Do You Weigh the Benefits and Risks of Aspirin?

Share your own aspirin story in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Citations
  • Craven LL, "Acetylsalicylic acid, possible preventive of coronary thrombosis." Annals of Western Medicine and Surgery, Feb. 1950.
  • Craven LL, "Prevention of coronary and cerebral thrombosis." Mississippi Valley Medical Journal, Sep. 1956.
  • Steering Committee of the Physicians' Health Study Research Group, "Final report on the aspirin component of the ongoing Physicians' Health Study." New England Journal of Medicine, July 20, 1989. DOI: 10.1056/NEJM198907203210301
  • Ridker PM et al, "Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial." Annals of Internal Medicine, May 15,1991. DOI: 10.7326/0003-4819-114-10-835
  • Zheng SL et al, "Association of aspirin use for primary prevention with cardiovascular events and bleeding events: A systematic review and meta-analysis." JAMA, Jan. 23, 2019. doi:10.1001/jama.2018.20578
  • Loomans-Kropp HA et al, "Association of aspirin use with mortality risk among older adult participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial." JAMA Network Open, Dec. 2, 2019. DOI: 10.1001/jamanetworkopen.2019.16729
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For most of my life I have taken aspirin with no ill effects. A few years ago I felt extremely weak and my heart was pounding. I went to the emergency room and was admitted to the hospital. I had severe stomach bleeding due to the aspirin and had to have two blood transfusions. I was sent home with instructions to never take aspirin in any form whatsoever.

An unmentioned risk of taking aspirin daily is that if you are scheduled for surgery it is suggested that you stop taking aspirin to better control bleeding. Stopping the aspirin will spike your risk of a heart attack. A quick and somewhat random search https://www.webmd.com/heart-disease/news/20110720/stopping-aspirin-risky-for-some#1

I was given Atacand for mild blood pressure issues which caused extreme shortness of breath. I discontinued that medication but was sent to a heart clinic. They found nothing wrong heart wise but recommended I take one baby aspirin per day which I did faithfully for 5 years. Then in 2013 I am flying from Atlanta to Houston, felt light headed, stood up, passed out throwing up blood. I am not sure how long I was unresponsive, but tried a second time to stand up with a repeat performance. Removed from the plane in Houston, sent to the emergency room, received blood transfusions, and the doctors confirmed that the ulcer was in fact aspirin induced. Remained in the hospital several days while undergoing testing and until I stabilized.

As prescribed by my doctor I had been taking a low dose baby aspirin every day for over 7 years. Recently I had a gastric bleed that resulted in a hospital visit and 4 units of blood. The doc at the hospital told me the bleed was caused by the aspirin I had been taking. So be very careful and question your doctor about using baby aspirin. I had never had gastric problems before this episode.

I’ve taken aspirin since I was a small child. I’m now 69. Other NSAIDs cause immediate vomiting or don’t work. My mother only took aspirin and my daughter cannot take anything else and has to use it for blood clots because of the side effects of other drugs. If people stopped to consider how few people compared to the general population are actually negatively impacted by this drug, they would understand that used in moderation, it’s as safe or safer than most other drugs.
My father had two heart attacks, my mother had congestive heart failure (I’m guessing from long-term use of inappropriate medications prescribed by an ignorant doctor.). I’m not going to stop.

I started taking aspirin every day after reading articles about its benefits in the early 1970s. No bad side effects so far, no cancers either (I am an obese 72-year-old female).

I used low dose aspirin for several years but it seemed to increase my tinnitus every time I took it, so I stopped.

I used to take aspirin daily tablets; but then found out that taking daily supplemental tablet dose of garlic, ginger and nattokinase is a much more effective and natural alternative as it does not cause the undesired resulting gastrointestinal bleeding typical of aspirin that I was experiencing.

I found over time that when the combined recommended daily dose of each nutritional supplement was taken; they all very effectively combined to work together help to dissolve any excess potential fibronitic coagulating molecules in ones blood and/or also any excess potential undesired collagen that is produced in ones body; that causes this undesired coagulation blood clotting in ones heart vessels that causes over time the premature heart attacks.

I wonder if a person should go back to good old aspirin for routine aches and pains. (back pain, headaches)?

I have been taking ibuprofen and naproxin for back pain. Although I have had NO side effects from these drugs I am starting to think that aspirin is safer(but maybe not as effective) Any thoughts from the People’s Pharmacy?

For long term use…..Aspririn or other NSAIDS?? Which is a safer choice?

I’m a 78 year-old chain smoker and I’ve taken a regular aspirin a day for decades, so I’m a believer. You don’t mention its anti-inflammatory property, but I do think that’s important, especially after reading about the dangers of chronic low-level infections, such as gum disease, etc.

Something else unmentioned is aspirin’s effect on sensitive stomachs. Baby aspirin and buffered aspirin should alleviate this. I try to take it on a full stomach and always with floods of water, but I have a daughter who needs daily aspirin who says she just can’t.

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