Aspirin All purpose drug?
Professor Nick Wald from University of London suggests that if the over-55s took aspirin as part of a “polypill’’ with other drugs it will have a major health impact. Aspirin may be cheap and not need a prescription, but it is still a powerful drug. And, like any medicine, it has risks as well as benefits. Research shows that aspirin increased the risk of miscarriage when taken by pregnant women. The risk was highest when aspirin was taken at the time of conception. In the study, 1,055 women in San Francisco who had positive pregnancy tests were asked about their use of non-steroidal anti-inflammatory drugs — painkillers that include aspirin — as well as about known risks for miscarriage. Women who had taken these drugs had almost double the risk of miscarriage compared to women who hadn’t.
The study shows that aspirin is associated with miscarriage. Dr Li De-Kun, an epidemiologist at Kaiser Foundation Research Institute believes that women should discuss the results with their doctors. Professor John Cleland, cardiologist, University of Hull believes that we may have embraced aspirin as a wonder drug too uncritically.“If you take aspirin, there is a risk of kidney failure, ulcers and major bleeding,’’ he says.
Aspirin is recommended for people who have already had a stroke or heart attack. “Doctors should be conservative about what they recommend in clinical practice,’’ says Cleland. “I would give it to people for the first six weeks after a heart attack because there are robust clinical trials that show it reduces further heart attacks.’’ In people with heart failure, Cleland is concerned that aspirin may counteract the proven and beneficial effects of drugs called ace inhibitors that major clinical trials show reduce the risk of death and hospitalisation. Joe Collier, professor of medicines policy at St George’s Hospital, London, is sure that whatever doubts there are about aspirin, it has been an enormous life-saver. “I am sure that low-dose aspirin has saved millions of lives by stopping second heart attacks and strokes,’’ he says, pointing out that there is no evidence for lots of things.
What interests him most about the aspirin story is how it has taken the m edical profession 100 years to begin to use aspirin to its full potential. “It is quite contrary to drug companies pushing through a drug and then replacing it, because the patent runs out — you never get to know the product fully. We are gradually learning about drugs such as aspirin, and morphine and water tablets. These drugs become your friend and you become able to use them better and better.’’
At Cancer Research UK, they are feeling increasingly friendly towards aspirin. “There are lots of observational studies looking at why some groups of people get cancer and some do not,’’ says Dr Richard Sullivan, head of Clinical Programmes at Cancer Research UK. “A paper published showed that aspirin could dramatically reduce the risk of cancers of the mouth, throat and gullet. People who took aspirin for at least five years, regularly (probably weekly) had their risk reduced by a third. Smoking and drinking habits, both of which increase the risk for these cancers were taken into account in the analysis.’’
How does aspirin stop cancer cells growing? “There is a protein, called Cox-2, on the surface of cancer cells,’’ explains Sullivan. This protein, he says, is part of normal inflammation, and cancer cells cause inflammation. Some forms of cancer cells have much more Cox-2 on their surface than normal cells. Aspirin binds to this protein and inhibits it. The latest claim for aspirin’s benefits — that it can treat an inherited skin condition called turban tumour syndrome — is published in Nature magazine. The researchers include a team from Cancer Research UK and, again, aspirin is thought to work by being able to damp down the over-active inflammation that encourages the tumour to grow. Proper trials are needed to see if aspirin, applied as a gel to these skin tumours, will shrink them. But Sullivan warns against people thinking that by taking aspirin they will ward off cancer. “For the average person to prevent cancer, it is not rocket science - if you smoke or if you are obese, then these are the risk factors to worry about,’’ he says.