“In the last several years there has been good cardiovascular research done in women. Previously much of the reluctance of doctors to prescribe aspirin to women was because there was no evidence to show specific benefits of aspirin for them. Now we have that,” says Jeffrey Berger, M.D., a cardiac fellow at Duke University.
Berger led a study of almost 100,000 adults, both men and women, testing the effects of aspirin dosages between 81 to 162 mg daily. The study found that aspirin significantly (by 12%) reduced the risk of stroke in women. (It should be noted the men in the study also benefited, but differently—their risk of heart attack dropped.)
Aspirin may have role in diabetes therapy
Fighting diabetes is another area in which experts are exploring chemicals related to aspirin. Specifically, they are looking at the possibility of these compounds fighting insulin resistance, the body’s inability to properly use its insulin.
“We could increase the body’s response using a very high dose (at least 4 gms) of aspirin, daily but that would be dangerous, spurring internal bleeding,” Shoelson says. Instead, Shoelson and his team turned to an older drug that formed the basis of aspirin, called salicylate, used to fight diabetes years ago.
“Salicylate targets a different pathway in the body so it doesn’t trigger aspirin’s negative responses,” he says. There were positive results in small clinical trials and Shoelson’s team is now in a large Phase III trial for adults ages 18 to 70 with type 2 diabetes, testing 3 to 4 gms. (You can get more information online at www.tinsal-t2d.org.)
Warfarin (and its generic version, coumadin) is a drug commonly used to fight stroke, specifically because of its ability to prevent blood clotting. Warfarin causes even more bleeding than aspirin and can cause fatal hemorrhage—but a stroke isn’t very good either. A National Institute of Neurological Disorders & Stroke study explored the question of whether aspirin could replace warfarin in fighting stroke. The study concluded that it could—in certain instances.
The advantages of the aspirin therapy studied were it required less physician oversight. and aspirin is much less expensive than warfarin. But there are also two negatives. Aspirin shouldn’t be used if someone has an irregular heartbeat. More importantly, the dosage the study used to get the positive benefits was very high: 1,300 mg.
That’s dangerous because like warfarin it could then cause excessive bleeding. For now, you should only consider converting to aspirin from warfarin or coumadin for stroke prevention after careful discussion with your physician.
Other negatives
When a headache or back pain strikes, most people grab for a bottle of large dose aspirin, around 325 mg. “The biggest mistake people make about aspirin is forgetting it is a medication. Just because you can buy it overthe- counter doesn’t mean it has no side effects,” Kroger says. Stomach and brain bleeding are two dangers if you take aspirin regularly. Aspirin is generally not recommended for people who have stomach ulcers, asthma, or kidney disease.
“To paraphrase an old saying, ‘Everything is potentially poisonous. The only thing that differentiates a poison from a remedy is the dose.’ This is especially true for aspirin. Used prudently, it is safe and effective, but when used excessively or in overdose amounts, it is one of the most dangerous drugs available. A total of 6,550 aspirin-related exposures were reported to U.S. poison centers in 2005,” Krenzelok says. That includes several fatalities.
Another possible negative specific to older adults and aspirin was published in a major medical journal. The study researchers were emphatic: the potential dangers of increased bleeding in people over age 70 weren’t worth aspirin’s benefits. Berger is hesitant to accept that recommendation.
“I don’t think we should use age as a cut-off. At every agepoint, and every change in your medication list, you should discuss aspirin use with your doctor. Older people are more likely to experience aspirin’s side effects, but they are also more likely to benefit by preventing the risk of heart attack and stroke,” Berger says.