To aspirin or not to aspirin?
Can daily aspirin dose significantly influence your health? A 24-year
long Nurses' Health Study by the researchers from
Massachusetts General Hospital and Harvard Medical School, Boston, rounded up
statistical results for long-term aspirin effects. They show that low-to-moderate aspirin users
within the group under study had cancer caused
deaths lower by 12% and cardiovascular by 38%, with a total of 25% lower death rate from
any cause (CNN, BBC).
The study followed nearly 80,000 women, 35 to 60 years
of age at the start in 1980, checking on their aspirin use every 2 years, up to
the year 2004 (average age went from 46 at the beginning to 70 at study's end). Within this group, over 40,000 did not use aspirin on regular basis,
nearly 30,000 used low-to-moderate dose of 1 to 14 325mg tablets per week, and
5,000 used more than 14 tablets per week.
There was no significant statistical difference in death rates between non-users
and high-dose aspirin users.
The problem with this study is that it contradicts earlier well established
studies that found no such benefits from taking aspirin. One of them, the
British Woman's Health Study, followed 40,000 woman for 11 years. And
several studies found that aspirin actually doubles the risk of stroke.
To make matters more confusing, the fact is that aspirin should - just as any other
blood thinning agent - lower, at least to some measurable extent, the risk of
heart attack. The reason is a silent,
widely ignored mass killer called "deep
vein thrombosis" (DVT).
Blood clots that usually form in large (deep) veins of
the legs travel to the upper body and get stuck in the vessels of lungs (causing pulmonary embolism), heart (heart
attack) or brain (stroke).
The risk factors for DVT are many, and they can outweigh
positive effect of blood thinner in any individual. However, positive effect should show in
large group's average. The fact that studies differ so much in their results
is, in good part, due to the difficulty of identifying and tracing
all factors that can influence the outcome (this goes for health-related studies in
Another problem of this study is that some major
numbers do not fit into well established general trends. While the
leading cause of death among women in the general population is
cardiovascular disease, in the study it is cancer, by a factor of 2.5
over cardiovascular diseases(4,469 deaths from cancer vs. just under
2,000 from cardiovascular disease). Even when adjusted for lower death
rates in low-to-moderate aspirin users group, cancer deaths
still outnumber those from cardiovascular disease by about a factor of 2.
Such a major discrepancy alone makes credibility of the study questionable.
Of course, any indirect study, depending on reports by participants
themselves, is less reliable than clinical studies controlling at least
major factors, such as the actual doses of the agents tested. In addition, the fact that it didn't take into account other important factors,
such as diet, forms of
lifestyle and other medications used makes study's result inconclusive
by its very concept.
is, why was such an inherently flawed concept chosen in the first place?
Poorly controlled studies are probably the main reason for confusing,
often contradictory results. A 1993 study published in the New England Journal of Medicine had the risk of
cardiovascular disease in a sample of over 87,000 nurses
cut by 41% with a daily dose of 100 I.U. of
vitamin E alone.
Some recent studies (GISSI Prevenzione Trial), on the other hand, had
found no benefit from it whatsoever. Part of the reason is that it does
matter which form of vitamin E one uses (synthetic is less potent, and
can have negative side-effects), in what dose, and also, for the natural
form, whether it includes only alpha-tocopherol, or all eight of its
Also, vitamin E is significantly more effective
when combined with vitamin C,
and both are significantly more effective when sufficient level of
other antioxidants like
lipoic acid and
coenzyme Q10 - which also restore used up vitamin C and E to
their antioxidant potential - are present. It is all important -
nutrient can compensate for
deficiency of other key nutrients.
To the contrary, vitamin E effectiveness can be significantly reduced by
antagonists like inorganic iron, synthetic estrogen and estrogen mimics,
chlorine, or high dietary intake of
This illustrates only a part of the complexity involved in such
studies. It is safe to say that no study so far has come close to
controlling all relevant factors, and many - including the one in the
question - don't even attempt to.
Assuming that the result of the study are correct, what would be its
importance? Even at the optimum dose, which is according to the study's results
about one 325mg tablet a day, the risk of ulceration and bleeding caused by
aspirin becomes significant.
On the other hand, the anti-clotting effect, which
is considered to be the main beneficial factor from the use of aspirin, can be achieved safely with
daily supplementation of vitamins C and E,
Omega-3 fatty acids, amino acid arginine, or
enzymes, in particular bromelain.
Arginine has additional vasodilating benefit, from stimulating nitric
Why would anyone risk ulceration, gastrointestinal bleeding,
Reye's syndrome (encelopathy and fatty liver), impared renal
function or stroke for questionable health
benefits by taking aspirin, if the benefits are certain with vitamins C, E, arginine
and/or bromelain - without any side effects (rather, with a few, or more,
Of course, benefits of a
healthy diet and lifestyle by far exceed
that of aspirin "supplementation".
Not mentioning these facts questions the integrity of those
promoting the "easy pill solution" to a potentially serious
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