Dear Alice,

I've heard that aspirin is a miracle drug with many benefits not yet fully understood. Is this true? If so, can aspirin substitutes provide the same benefits?


Dear Tylsalicilic,

Media reports on the use of aspirin and other over-the-counter pain medications to prevent or treat diseases such as heart attacks and cancer leave many people struggling to keep all the facts straight. Others who cannot tolerate aspirin might feel a bit left out as new uses and benefits of aspirin continue to appear in the news.

Aspirin is a member of a class of substances called non-steroidal anti-inflammatory drugs, or NSAIDs. Two other popular pain relievers, ibuprofen and naproxen, are also NSAIDS. These drugs reduce pain, fever, and inflammation, and are used to treat a variety of conditions. Aspirin has yet to achieve "miracle drug" status, but promising results indicate that the drug can play a role in reducing the risk of, preventing, or possibly even managing certain health problems, including:

  • Heart attack: Most notable is aspirin's benefit for those who have already had a heart attack; the regular use of aspirin by such individuals has been shown to lower their risk of a second heart attack. There is also evidence that aspirin can reduce the risk of a first heart attack for people in high-risk categories. Finally, aspirin may decrease the risk of death when taken immediately after the onset of a heart attack. Aspirin is an antiplatelet drug — it works against the aggregation of platelets in the blood, thereby helping to prevent blood clotting and potentially reducing the risk of a heart attack. Though ibuprofen and naproxen also have antiplatelet effects, they have not been found to reduce this risk.
  • Stroke: Aspirin's antiplatelet action may also help to prevent clot-related, or ischemic, strokes.
  • Cancer: Some studies have found that aspirin could lead to lower risks of certain types of cancer, including colorectal, prostate, stomach, and possibly breast. Ibuprofen and naproxen have also been linked to lower rates of colorectal and stomach cancers. The anti-inflammatory action of these three drugs is thought to play a role in this reduced risk. Other studies have suggested that aspirin and acetaminophen (a non-NSAID over-the-counter pain reliever) may lower the risk of ovarian cancer, but these findings have been disputed.

In all cases, more research is needed to determine what benefits aspirin and other pain relievers may provide and whether these benefits would outweigh the potential side effects. Aspirin, for example, is known to cause gastrointestinal bleeding with heavy use, and there is research that indicates an increased risk of bleeding-related, or hemorrhagic, stroke in people who use it regularly. Currently, the American Heart Association recommends aspirin therapy for people who have already had a heart attack or ischemic stroke. However, there are no other agreed-upon guidelines for the use of any of these pain medications in patients with or at high risk for the above diseases. Instead, the possible risks and benefits should be weighed on a case-by-case basis.

Before you start taking any of these over-the-counter drugs on a long-term basis, it's a good idea to discuss it with your health care provider. S/he can determine whether you would benefit from such preventative treatment, discuss possible side effects, determine the right dose (it may be smaller than those typically used for pain relief), and ensure that any other medications you take won't cancel out the effects or cause an unwanted interaction. For anyone worried about diseases such as heart disease, stroke, and cancer, the best preventative medicine is a healthy lifestyle that includes a well-balanced eating plan, stress management, and regular exercise. You can always discuss diet and lifestyle as a means of disease prevention with your health care provider or nutritionist, too.

If you are thinking about daily aspirin use, there are several resources you can check out to learn more. The U.S. Food and Drug Administration has more information on the safety of daily aspirin use on their website. The American Heart Association covers information about the use of aspirin in preventing heart attack and stroke and is a comprehensive source of information about coronary disease in general.  Lastly, the American Cancer Society is a clearinghouse for all types of cancer news and has many articles on aspirin's use in fighting specific forms of the disease.


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