Should you be taking aspirin every day It can help prevent stroke and heart attacks but which of us really needs a daily dose

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UPDATED:

21:00 GMT, 18 August 2012

Seldom does an every-day remedy command such debate but in
households throughout the land the same question is being asked: should
we be taking aspirin to save us from serious ill-health

Now the experts have given their definitive verdict on
the great health question of the day. Who should really be taking it –
and who most definitely should not

Their answer was unequivocal.
No one should be taking daily aspirin, unless specifically told to by
their doctor.

‘We don’t recommend daily aspirin for the worried well,’
says consultant cardiologist Dr Tushar Salukhe at London’s Bupa Cromwell
Hospital. ‘A minority of long-term users will suffer internal bleeding,
so the risks may outweigh the benefits.’

Hilary Devey

Sophie Ellis Bextor

Tony Blair

Dragon's Den panellist Hilary Devey, left, and singer Sophie Ellis Bextor, middle, should be taking an aspirin every day, while former PM Tony Blair, right, should refrain

A daily dose of 75mg – a
quarter of a regular strength aspirin – is recommended, in the case
of specific illnesses. ‘A tiny amount is enough to bring about
beneficial changes in the blood,’ says Professor Sir John Burn at the
Institute of Genetic Medicine, Newcastle University.

The most recent
study on the subject, from the American Cancer Society, showed that
daily use of the drug was linked to an estimated 16 per cent lower risk
of cancer mortality. Its benefits in stroke and heart-attack prevention
are well known.

The drug blocks the action of prostaglandins,
chemicals that cause pain and swelling and are released when the body’s
cells are damaged. It also blocks the action of chemicals that make
blood clots.

‘Aspirin should never be given to under 16s,’ adds
Dr Helen Sammon, of the Royal College of Paediatrics. ‘It could trigger
a potentially fatal condition called Reye’s syndrome.’

Unequivocal advice: No one should be taking daily aspirin, unless specifically told to by their doctor

Unequivocal advice: No one should be taking daily aspirin, unless specifically told to by their doctor

YOU SHOULD BE TAKING DAILY ASPIRIN IF…

… YOU'RE MIDDLE AGED WITH A FAMILY BOWEL CANCER HISTORY

‘For those with a family history of bowel cancers – father, mother, brother or sister – I would say it is definitely worth taking aspirin,’ says Prof Burn.

He led a trial that showed taking high-dose aspirin for at least two years could reduce the incidence of bowel cancer by 63 per cent in a group of 861 patients with Lynch syndrome, a genetic condition that increases the risk of colorectal cancer.

TV presenter Matthew Wright is a sufferer. ‘Fifty per cent are likely to get cancer before retirement age,’ says Prof Burn.

HOW IT WORKS: Aspirin is thought to prevent the development of pre-cancerous growths in the bowel known as polyps. ‘We think some of the chemicals in the drug may kill faulty cancerous cells,’ says Prof Burn.

WHEN TO TAKE: ‘Those who are 50-plus. Taking aspirin under 40 is recommended only in the highest risk groups. If you have had a close relative with colon cancer – a parent or sibling – then start taking aspirin five years younger than they were diagnosed as there is probably a three to five-year time-lag in the protective effects,’ says Prof Burn. If you have Lynch syndrome, go to capp3.org for more about his forthcoming trials.

… YOU HAVE SUFFERED A HEART ATTACK

‘In heart disease, plaque builds on the insides of blood
vessels, and blood clots form which can block the arteries and cause
heart attack,’ says Dr Salukhe. ‘There is irrefutable evidence that
taking aspirin in coronary disease or following a heart attack saves
lives.’

HOW IT WORKS: ‘In small blood vessels, such as coronary arteries,
platelets may stick to areas roughened by disease. Aspirin inhibits the
tendency of platelets to stick together,’ says consultant cardiologist
Paul Silverton. ‘This is often the initial stage in the formation of a
blood clot.’

WHEN TO TAKE: Following a heart attack –
something American TV chat show legend Larry King suffered in 1987,
aged 54. It is not yet proven that aspirin can help prevent a first
heart attack.

… YOU HAVE SUFFERED A STROKE

‘A thrombo-occlusive (ischaemic) stroke is akin to a heart
attack, in that it is due to blocked arteries – in the brain – and
accounts for 87 per cent of cases,’ says Dr Salukhe. More rarely a
(haemorrhagic) stroke can be caused by bleeding in the brain.

HOW IT WORKS: Aspirin inhibits the formation of blood clots in the vessels supplying blood to the brain.

WHEN TO TAKE: ‘Following a thrombo-occlusive stroke, you are likely to
be prescribed 75mg of aspirin daily,’ says Dr Salukhe. This is the
kind of stroke suffered by Dragon’s Den panellist Hilary Devey,
pictured, in 2009, when she was 51. ‘Haemorrhagic stroke occurs when a
weakened blood vessel ruptures in the brain. Anti-clotting agents such
as aspirin may cause further bleeding and should be avoided.’

… YOU ARE PREGNANT AND TAKING A FLIGHT

‘Pregnant women are at increased risk of DVT – blood clots in the
deep veins of the legs,’ says Clive Spence-Jones. ‘The risk of
thrombosis in all pregnant women is eight times higher than normal
people, with older mums and the overweight more at risk.

In pregnancy,
coagulation, platelet function and clotting factors are all affected due
to hormonal changes. There are no clinical studies into DVT and
pregnancy, but we think it reduces the risk. We never use high doses in
pregnancy because of Reye’s syndrome,’ he adds.

HOW IT WORKS: /08/18/article-2190294-07DC49E3000005DC-757_306x397.jpg” width=”306″ height=”397″ alt=”Aspirin” class=”blkBorder” />

If you think taking daily aspirin is a harmless way of improving
overall health, think again. The risk of serious side effects is very
low. But recent Italian research showed that long-term, low-dose aspirin
usage was linked to a 55 per cent higher risk of bleeding in the
digestive system, and a 54 per cent higher risk of bleeding in the
brain.Those with pre-existing gastric problems, such as a peptic
ulcer, should take aspirin only after discussing it with their doctor.Aspirin
may cause asthma attacks in one in ten adults. If you suffer from
asthma, talk to a medical adviser before taking it even for a headache.Anyone
with an allergy to aspirin, a bleeding or clotting disorder or who
bleeds easily needs to see their doctor. ‘If you bruise easily, aspirin
will make it worse,’ say Professor Weissberg, medical director of the
British Heart Foundation.‘Take after food to reduce irritation to the lining of the stomach,’
says Prof Weissberg. You may be offered medicines that reduce production
of gastric acid.

DON'T BOTHER TAKING DAILY ASPIRIN IF…

… YOU ARE WORRIED ABOUT DVT AFTER AN OPERATION

‘Aspirin isn’t strong enough to counteract post-operative blood
clots,’ says John Scurr. The most common reasons for elective surgery
requiring a hospital stay are hernia repairs – singer Madonna has had
three such operations.

‘There is now a formal government directive
whereby all patients are given a risk assessment for blood clots. If
you are considered to be moderate to high risk, you will be given
heparin before the operation.’

… YOU ARE WORRIED ABOUT BREAST CANCER

‘In 2010, a study on women with breast cancer showed taking regular
aspirin lowered the risk of dying from breast cancer by 70 per cent,’
says consultant surgical oncologist Charlie Chan at Cheltenham’s
Nuffield Health. ‘No other studies on the use of aspirin in breast
cancer sufferers have been published. In breast cancer prevention, the
evidence is not conclusive.’

This year, two large analyses on
170,000 healthy people showed that daily aspirin lowered the risk of any
cancer death by eight to 15 per cent. However, neither of these
analyses showed a definite lowering of the risk of dying from breast
cancer, which comedian Jennifer Saunders was diagnosed with in 2009.

Dr
Chan says: ‘There isn’t enough compelling evidence to prove the
benefit of taking aspirin for breast cancer outweighs the risks. This
may change in the future.’

… YOU ARE DIABETIC AND OTHERWISE WELL

‘Cardiovascular disease is a serious complication from diabetes, accounting for 48 per cent of deaths from the condition,’ says Deepa Khatri of Diabetes UK. ‘However, it is not recommended patients take aspirin prophylactically, only if given for pre-existing conditions.’

Guidelines changed in 2010 when experts assessed nine studies into treating diabetes with aspirin and concluded the benefits were adequate to merit its use. ‘Diabetics may be tempted to try it as a preventative measure, but there’s no evidence it is worth the risk of bleeding,’ says consultant endocrinologist Professor Ashley Grossman.

… YOUR HEARTBEAT’S IRREGULAR

A report this year suggested GPs shouldn’t be prescribing aspirin for the heart rhythm problem atrial fibrillation, where the upper chambers of the heart beat out of rhythm. Blood can pool and clots form which may cause a stroke.

‘Aspirin is useless in treating atrial fibrillation,’ says Martin Cowie, Cardiology professor at the Royal Brompton Hospital.

Tony Blair, pictured, underwent surgery for atrial fibrillation in 2004.

‘New guidelines recommend Warfarin or another anti-coagulant, which reduces the risk of stroke by up to 70 per cent. Other forms of arrhythmia don’t increase the risk of clot, so aspirin is not an issue.’

… YOU LEAD AN UNHEALTHY LIFE

‘Aspirin isn’t a panacea,’ says consultant cardiologist Paul Silverton. ‘Some people develop conditions in spite of a very healthy lifestyle, perhaps due to genetic factors. But in many diseases – heart disease, ischaemic stroke, diabetes and cancers – lifestyle is known to play an important part.

‘Taking aspirin isn’t going to counteract damage caused by smoking, being overweight, and too much alcohol. It’s important to address these issues before considering prophylactic aspirin.’

French actor Grard Depardieu, left, had open-heart surgery in 2000 but still drinks enthusiastically.