Aspirin, a pain and fever remedy that prevents heart attacks, strokes and possibly cancer

Aspirin, like ibuprofen and Voltaren (diclofenac), is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and relieve fever.

What distinguishes aspirin from other NSAIDs is its ability to dilute the blood, and it is used to prevent blood clotting in people at risk for heart disease and strokes. Recently, it has also been shown that the risk of some types of cancer can be reduced.

How does it work?

Aspirin inhibits an enzyme called cyclooxygenase, which produces prostaglandins. These in turn are associated with inflammation, pain and fever.
Through the same enzyme aspirin also inhibits the production of substances called thromboxanes. These are responsible for the accumulation of platelets in the blood, a process that is required for hemostasis. That is what we mean when we say that aspirin "dilutes the blood".
The mechanism by which aspirin may protect against cancer is not fully understood. However, certain genetic and other features may identify those that might be of particular use.

History

In the 16th century BC Documented Egyptians on papyrus that the bark and leaves of willows and related plants had analgesic and anti-inflammatory properties. The Greek physician Hippocrates noticed these features later in the 5th century BC.
The recent history of aspirin goes back to the purification of salicylate, the active ingredient in ancient preparations. In 1897, this culminated in the development of acetylsalicylic acid or aspirin. Today's interest in aspirin derives mainly from the pioneering publication of 1971 by the English pharmacologists John Vane and Priscilla Piper, who discovered their action in inhibiting prostaglandin production. In 1982, Vane received the Nobel Prize in Physiology or Medicine for his work in the field.

John Vane Vane received the [Nobel Prize for Physiology or Medicine] for his work on prostaglandins. The Nobel Foundation website / screenshot
In 1950, American general practitioner Lawrence Craven noted that patients who had tonsils removed and chewed Aspergum (a gum with aspirin) experienced severe bleeding. He later said daily aspirin seemed to prevent heart attacks in his patients.

Craven's claims were challenged by other doctors because they were not the subject of randomized trials. This was around the time when the importance of blood clots in events such as heart attack was recognized and a methodology was developed that provided for the robust design and interpretation of very large clinical trials.
These studies included aspirin as one of the first therapies tested. A recent review of such studies showed that aspirin reduced serious vascular events, such as heart attack and stroke, by about 12% in those who did not previously have such diseases compared to inactive placebo, and about one-fifth in those who had such diseases ,

Craven found that patients who chewed Aspergum had severe bleeding. Drugstore News / Screenshot
However, the review also confirmed that the benefits at the expense of severe bleeding (due to the ability of aspirin to prevent coagulation) from the stomach and intestines or led to bleeding in the brain. It is now apparent that factors such as increasing age and smoking play a role and diabetes not only increase the risk of heart attack and stroke, but also heavy bleeding. This means that aspirin can not be prescribed indiscriminately for everyone.

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Aspirin and cancer

In 1988, Melbourne surgeon Gabriel Kune reported that aspirin had been associated with lower colorectal cancer rates.
Later, studies confirmed a reduction in the rate of cancer and death in people taking aspirin, not only in the gut, but also in some other types of organ. However, at the beginning of these studies, cancer was not identified as a major concern and for that reason was not rigorously studied.

How is it used?

The Australian guidelines for the use of low-dose aspirin to prevent cardiac events and strokes are clear. If Aspirin does not cause problems, such as For example, severe bleeding should be used throughout life for those with cardiac events such as angina, heart attack, coronary artery bypass graft, and stroke.For those who have not experienced this, the decision to use aspirin must be based on balancing individual bleeding risk and future events.

The latest, authoritative recommendations of the US Preventive Services Working Group on Cardiovascular and Colorectal Cancer Prevention indicate that the use of aspirin in 50- to 69-year-olds depends on the estimated risk of events that could potentially be prevented, as well as on Bleeding and life expectancy.

For persons under the age of 50 or over 70, there is insufficient evidence to assess the balance of benefit and harm in the induction of aspirin use.
Current Australian Prevention of Colorectal Cancer Policy: There is not enough evidence to recommend aspirin to all people at average risk, and it is emphasized that improvements in diet and lifestyle as well as screening effectively reduce the risk.

However, individuals with a strong family history of colorectal cancer should often be referred for specialist evaluation, and aspirin may be recommended after genetic testing.
In the 50- to 69-year-olds, taking aspirin depends on the estimated risk of events that could possibly be prevented, as well as on bleeding and life expectancy. from shutterstock.com
The commonly used low dose of aspirin is 100 mg daily. This is much less than what could relieve headaches, other pains or fever, and for which acetaminophen is usually recommended in the first place.

Who should not use it?

The use of aspirin should be discussed with a physician as it should not be used in patients who have previously been allergic to aspirin or other NSAIDs, who are pregnant or breast-feeding, who have bleeding or coagulation disorders, who have active gastric bleeding or a history Bleeding had occurred after treatment with aspirin, gastritis or an active or previous gastric ulcer, gouty history or severe renal or hepatic failure. Aspirin should be taken with water, with or without food. The use of an enteric-coated tablet to prevent the release of aspirin in the stomach reduces the risk of stomach upset.

How much does it cost?

Aspirin is relatively cheap and the cost can range from $ 0.95 for a 24-pack of 300 mg tablets and $ 2.99 for 100 100-mg tablets.

Other interesting points

The ongoing ASPREE study (ASPirin in Reducing Events in the Elderly), which was conceived and initiated in Australia, has completed recruitment and has monitored more than 16,700 healthy Australians aged 70 and over, and nearly 2,500 people in the US. There are more than 2,000 Australian general practitioners involved as co-investigators.

The main question being investigated is whether aspirin improves healthy active life years (time without dementia or physical disability), results that are of fundamental importance to the elderly. This includes the net effect of the benefits and risks of aspirin.
The study will also provide clear data on whether aspirin prevents cancer in the elderly. The results of ASPREE are expected to be published in 2018.