By Jane E. Brody
Published: February 23, 1994
"CHEAP 100-Year-Old Household Drug Found to Fight Heart Attacks, Strokes, Cancer, Etc." sounds like a too-good-to-be-true headline. But dozens of studies involving more than a million people have hailed such a drug. It is none other than ordinary aspirin, the standby for reducing pain, fever and inflammation.
The findings of recent studies strongly suggest that an aspirin a day -- or at least every other day -- may be better than an apple at keeping the doctor away. Aspirin, these studies indicate, can reduce a person's chances of suffering a heart attack or stroke and of developing cancers of the colon and other digestive organs. It may also improve brain function in people with dementia who have suffered little strokes, ward off or reduce the severity of migraine headaches and help prevent hazardous high blood pressure in pregnant women. Also being studied are aspirin's possible roles in preventing cataracts and averting recurrences of gallstones.
And, in general, these benefits accrue from very low doses of the drug, known chemically as acetylsalicylic acid, derived from a substance in the bark of the willow tree that was used medicinally by the Greek physician Hippocrates in the 5th century B.C. But aspirin did not officially enter the medical armamentarium until the 1890's, when a chemist who worked for the Bayer Division of a German pharmaceutical company developed it partly out of a desire to relieve his father's painful, crippling arthritis.
Hailed as the closest thing to a pain-relieving panacea, aspirin soon became one of the world's most widely used drugs. Despite heavy competition from other nonprescription painkillers in recent decades, aspirin still leads the pack; Americans take about 30 billion aspirin tablets a year. Modern Aspirin
When scientists in the 1960's and 1970's finally unraveled how aspirin works chemically in the body, the drug assumed a whole new life. Aspirin was found to block the production of substances called prostaglandins. Among many other actions, prostaglandins promote the clumping of blood cells called platelets, a crucial step in the formation of blood clots that could precipitate heart attacks and strokes. The finding supported the unheeded claim of a California doctor who had observed in the 1950's that regular doses of aspirin seemed to prevent heart attacks and strokes.
In a well-designed five-year study of 22,000 middle-aged doctors, those who took one ordinary aspirin tablet every other day suffered 40 percent fewer heart attacks than those given a look-alike dummy medication. A similar placebo-controlled study is now under way in women. It has already been noted in a six-year study of nearly 90,000 nurses that those who said they took one to six aspirins a week suffered 25 percent fewer heart attacks than nonaspirin users.
Aspirin had previously been found to be effective in treating heart attacks; when given within hours of an attack (the sooner the better), it was shown to reduce deaths by 25 percent. And when taken regularly by heart attack patients, it reduced cardiovascular deaths by 23 percent and reduced the risk of a second nonfatal attack as well as nonfatal strokes by nearly 50 percent. Based on these findings, experts have urged that a supply of aspirin be kept wherever a heart attack victim might not be able to receive immediate medical attention. Such places include planes and ships, in backpacks, purses and cars, at health clubs and tennis courts and, of course, in homes. Aspirin Against Cancer
The latest excitement surrounds the observation that regular users of aspirin have reduced rates of cancers of the colon, rectum, stomach and esophagus. These cancers combined cause about 81,000 deaths a year in this country. Colorectal cancer alone is the nation's second leading cause of cancer deaths and the leading cancer killer among nonsmokers.
The most telling study to date, conducted by the American Cancer Society, involved more than 660,000 men and women whose health status has been monitored for a decade. It suggested that as aspirin use rose, the risk of cancer death fell; those who used aspirin 16 or more times a month were about half as likely to die of colon cancer as nonusers.
Looking at all four digestive system cancers together, cancer society researchers found a 40 percent lower death rate among men and women who used aspirin 16 or more times a month for at least one year. And the longer aspirin had been used, the lower the risk, they reported.
Other studies have supported the cancer society's findings, although proof of aspirin's benefit in the form of a placebo-controlled study has yet to be obtained. But one controlled study of an aspirin-like drug, sulindac, showed that it could inhibit the growth of polyps in people genetically prone to developing polyps that ultimately become cancerous.
Aspirin may also be useful in fighting cancer. It stimulates production of two cancer-fighting components of the immune system: gamma interferon and interleukin-2. Researchers are now studying its effect as an adjunct to conventional treatment. Proceed With Caution
Despite its long history and popularity, aspirin does have side effects that can become serious in some people. It increases bleeding tendencies and in some people causes bleeding in the stomach, an effect that can often be countered by using enteric-coated aspirin. The larger the dose, the more likely this problem will occur. It is therefore fortunate that most of the benefits newly attributed to aspirin, especially the cardiovascular effects, involve very low doses: one ordinary aspirin tablet (325 milligrams, or 5 grains) every other day or one baby aspirin (80 milligrams) daily.
More is not better. In fact, it may be worse.
Preventive aspirin therapy is most often recommended for men over 40 and women over 50 who have one or more major risk factors for heart disease, including smoking, a family history of heart attack before 55, high blood pressure, unfavorable cholesterol levels, obesity or diabetes.
Most researchers say it is too soon to recommend aspirin as a cancer preventive, except perhaps for those with a family history of colon cancer. Here again, low doses seem effective: one adult or one baby aspirin each day.
Some people should not take aspirin on a regular basis: those who have had any sort of bleeding disorder (including hemorrhagic stroke), stomach ulcers, uncontrolled high blood pressure, eye problems related to diabetes, kidney or liver disease or a personal or family history of cerebral aneurysms. Aspirin also should not be used by people already taking an anticoagulant or some other nonsteroidal anti-inflammatory drug like ibuprofen.