Not long ago, a patient who came to discuss possible alternative treatments for his heart said that he was completely against taking cardiology drugs, and that all he used was one aspirin a day. I have heard similar comments from other patients: “My cardiologist practically begged me to take aspirin,” or, “No, I never take drugs of any sort, only the one aspirin per day.” Generally, I used to let these comments slide because I believed that we had more important issues to decide than whether the patient should take aspirin.
I have heard aspirin described as one of the greatest medical interventions of the twentieth century, almost as important as the discovery of penicillin. On the other hand, I have read credible accounts that link the widespread and aggressive use of aspirin to the tragic outcomes in the 1918 flu pandemic.1 Others suggest that if aspirin were a new drug, it would never pass Food and Drug Administration (FDA) scrutiny because of its significant toxicity. Ironically and tragically, I am sure my mother’s fatal hemorrhagic (bleeding) stroke three years ago was caused by the combination of statins, fish oil and daily aspirin use.
Tens of millions of Americans take an aspirin a day, mainly for one of two indications. Generally, the most common indication for the widespread use of aspirin is to prevent the clotting (or thrombosis) of the blood, which is considered an integral step in the development of heart attacks and strokes. Second, as aspirin is a prostaglandin inhibitor (and, therefore, an anti-inflammatory), it is used in the primary prevention of diseases that are thought to be caused by chronic inflammation, including colon cancer.
I finally decided to look into the actual studies on aspirin use to see if I could find out whether everyone older than sixty should really take an aspirin a day, and, if not, whether downsides to its use exist.
INEFFECTIVE OR WORSE
So, what do the actual studies show? The first study, published in 2010, comes from the journal Expert Opinion on Pharmacotherapy.2 The researchers studied the role of aspirin in the primary prevention of cardiovascular disease in patients with diabetes. Primary prevention means that these patients were diabetic but had no history or evidence of heart disease. However, the fact that they had diabetes put them at high risk for heart disease, and aspirin was studied as a low-risk, low-cost primary prevention therapy. The study concluded that “aspirin therapy did not reduce the risk of cardiovascular events,” and that “the use of aspirin cannot be routinely recommended for primary prevention of cardiovascular events in diabetes.” In other words, the researchers found that aspirin was ineffective in preventing cardiovascular disease in patients who had diabetes but no existing heart disease at the time.
The second study, also from 2010, comes from the prestigious Journal of the American College of Cardiology.3 The study was designed to determine the outcome for patients who were taking aspirin prior to having a coronary event. By way of background, the researchers noted the existing “controversy” regarding whether prior aspirin use predicts worse outcomes in patients who go on to experience acute coronary events. This question is important because this is the predominant indication that doctors use in prescribing aspirin therapy. Here is the actual conclusion of the study: “Prior aspirin use was associated with more comorbidities and coronary disease and a higher risk of recurrent [myocardial infarction], but not mortality.” Stated another way, people taking aspirin had worse outcomes and a higher risk of having a heart attack than those not taking aspirin—exactly the opposite of what the doctors told them.
The third study, appearing in 2005 in the gold-standard New England Journal of Medicine, examined whether aspirin use lowered the risk of cardiovascular disease for women in general.4 The study concluded, “In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes, leading to a nonsignificant finding with respect to the primary end point.” Specifically, the researchers found a lowered risk for one type of stroke (ischemic, or blood clot, strokes), but aspirin did not affect the overall death rate from cardiovascular events. However, this study found no clear evidence that aspirin helped prevent hemorrhagic (bleeding) strokes, while another study in the journal Stroke identified clear evidence that, in women, taking aspirin daily increased the risk of both types of strokes.5 The conclusion stated: “Aspirin use was associated with increased risks of ischemic stroke in women and hemorrhagic stroke overall in this elderly cohort, after adjustment for other stroke predictors.” In other words, at least in women older than age sixty-five, daily aspirin use was shown to increase the risk for strokes.
MORE EVIDENCE OF A DOWNSIDE
Some positive trials do exist with regard to secondary prevention in men who have already had a heart attack or stroke. However, even this strategy is not without a significant downside. Again, studies show that aspirin is far from a benign drug. For example, a 2010 study published in The American Journal of Medicine showed that chronic aspirin use is associated with significant hearing loss in men and especially in younger men.6 As summarized by the authors, “Regular use of aspirin, NSAIDs [nonsteroidal anti-inflammatory drugs], or acetaminophen increases the risk of hearing loss in men, and the impact is larger on younger individuals.”
A 2009 study from the journal Current Medical Research and Opinion found that even low-dose aspirin therapy is associated with significant gastrointestinal toxicity: “Data suggest that ASA [acetylsalicylic acid or aspirin] causes significant gastroduodenal damage even at the low doses used for cardiovascular protection. These effects (both systemic and possibly local) may be pharmacodynamically distinct from the gastroduodenal toxicity seen with NSAIDs.”7
Finally, a 2011 study in Alimentary Pharmacology and Therapeutics linked daily aspirin use with the development of Crohn’s disease (CD), an illness becoming increasingly prominent in our medical landscape. The authors reported “a strong positive association between regular aspirin use and CD” (but not ulcerative colitis).8
I could go on for pages, but the bottom line is clear: while low-dose daily aspirin therapy has been shown to have some usefulness in very specific situations, it is far from a safe or effective medicine for all those who use this therapy.
Are there alternatives to low-dose aspirin therapy? Many natural medicines inhibit platelet aggregation, thin the blood and reduce inflammation without any of the risks incurred from low-dose aspirin therapy. Some of my favorite choices include the use of the enzymes nattokinase or lumbrokinase, both of which have shown anti-clotting effects as well as heart-strengthening properties.
In addition, a 1999 study showed that pycnogenol, the French pine bark extract, not only inhibited platelet aggregation in smokers (a high-risk group) as effectively as aspirin, but also did it without adversely affecting bleeding time.9 Published in the journal Thrombosis Research, the study reported the following: “Thus, smoking-induced enhanced platelet aggregation was inhibited by 500 mg aspirin as well as by a lower range of 100-125 mg Pycnogenol. Aspirin significantly (p<0.001) increased bleeding time from 167 to 236 seconds while Pycnogenol did not. These observations suggest an advantageous risk-benefit ratio for Pycnogenol.” (Probably the best source of pycnogenol is from the French Glory website.10)
In summary, the daily use of even low-dose aspirin is an important medical decision, one not without significant risk. It is important to discuss the risks and benefits with one’s primary physician and cardiologist and make sure they are aware of the downsides of this therapy and safer alternatives.
1. Starko KM. Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence. Clin Infect Dis 2009;49(9):1405-1410.
2. Younis N, Williams S, Ammori B, Soran H. Role of aspirin in the primary prevention of cardiovascular disease in diabetes mellitus: a meta-analysis. Expert Opin Pharmacother 2010;11(9):1459-1466.
3. Rich JD, Cannon CP, Murphy SA, Qin J, Giugliano RP, Braunwald E. Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol 2010;56(17):1376-1385.
4. Ridker PM, Cook NR, Lee IM et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352(13):1293-1304.
5. Kronmal RA, Hart RG, Manolio TA, Talbert RL, Beauchamp NJ, Newman A. Aspirin use and incident stroke in the cardiovascular health study. CHS Collaborative Research Group. Stroke 1998;29(5):887-894.
6. Curhan SG, Eavey R, Shargorodsky J, Curhan GC. Analgesic use and the risk of hearing loss in men. Am J Med 2010;123(3):231-237.
7. Yeomans ND, Hawkey CJ, Brailsford W, Naesdal J. Gastroduodenal toxicity of low-dose acetylsalicylic acid: a comparison with non-steroidal anti-inflammatory drugs. Curr Med Res Opin 2009;25(11):2785-2793.
8. Chan SS, Luben R, Bergmann MM et al. Aspirin in the aetiology of Crohn’s disease and ulcerative colitis: a European prospective cohort study. Aliment Pharmacol Ther 2011;34(6):649-655.
9. Putter M, Grotemeyer KH, Wurthwein G et al. Inhibition of smoking-induced platelet aggregation by aspirin and pycnogenol. Thromb Res 1999;95(4):155-161.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2018.