Take Two Aspirin and - No, Wait! I Didn't Mean It!

"A baby aspirin a day is healthy; but more than that can be dangerous"

"High Doses Of Aspirin May Reduce Colon Cancer Risk"

Far be it from me to raise the irksome voice of cynicism so often heard emanating from cable television squawkfests these days, but do I detect a contradiction in these headlines? On the one hand we have a meta-analysis performed by researchers at the University of Kentucky (published in the May 9, 2007 issue of JAMA) showing that people who ingest over 81 mg of aspirin a day increase their risk of gastrointestinal bleeding without providing any additional protection from myocardial infarction or stroke.

Higher doses of aspirin, though, are required to prevent colon polyps from forming (via COX-2 pathway inhibition), and as we all know, almost all colon cancers arise from colon polyps.

The May 12, 2007 issue of The Lancet contains another study showing the benefits of higher doses of aspirin. In this report, taking at least 300mg of aspirin daily for five years reduced the occurence of colon cancer by 63% to 74% over the next 14 years.

The British Doctors Aspirin Trial originally included 5,139 male physicians randomized to 500 mg aspirin or no aspirin for five to six years. Participants were not blinded to treatment.

The U.K. Transient Ischemic Attack Aspirin Trial (UK-TIA) included 2,449 patients who'd had a recent TIA or minor ischemic stroke. Patients were randomized to 300 mg or 1,200 mg aspirin a day or a placebo for one to seven years depending on the date of randomization.

The greatest benefit [in reducing the risk of developing colon cancer] was seen after five or more years of aspirin use 10 to 14 years after randomization (HR 0.37, 95% CI 0.20 to 0.70, P=0.002), particularly for those who were compliant (HR 0.26, 95% CI 0.12 to 0.56, P=0.0002).

As with many clinical trials one can skillfully spin the data into a silky reassurance that none of us will ever die if we take the correct pills. Critics, though, will undoubtedly point out key flaws in the fabric. The high-dose aspirin study, for example, has this caveat:

The researchers noted, however, that there was no data on aspirin use after the trials ended and neither trial was designed to study colorectal cancer.

Not only that, it is common knowledge that "occasional or irregular" use of aspirin provides no benefit in protecting against colon cancer. We the people are now faced with a dilemma over the best dose of aspirin to take. Just to make it more interesting let's list some of the consequences of gastrointestinal bleeding caused by aspirin and NSAIDs:

100,000 hospitalizations per year
16,500 deaths per year
Annual total cost of care for GI complications: over 2 billion dollars

It doesn't take a genius I.Q. to deduce that high-dose aspirin, just like any other NSAID, should be used with great caution in patients at increased risk for gastrointestinal bleeding. Experts (known as "thought leaders" by Big Pharma" - a rather Orwellian term, eh?) recommend that only patients at high risk for developing colorectal cancer take daily aspirin above the standard 81mg dose.

So where's the news-you-can-use in all of this? Far be it from me to raise the shrill voice of buttinskiism [is that a word? -Ed.] so often heard reverberating from grottos where the diktats of the Nanny State are contrived, but I do believe if one has an increased risk of stroke or heart attack it might be prudent to consult with one's physician about the use of low-dose aspirin therapy. Similarly, if one's risk of colorectal cancer is high one might ask one's personal medico about this report on high-dose aspirin.

Remember, these are just friendly suggestions given in the spirit of universal love and respect for all (no exceptions) - no different than what your Aunt Clara told you when you were just a gangly teenager. Those have an aversion to long lives, or who perhaps are basking in unbridled popularity by adopting a personal philosophy of laughing in the face of death are free to carry on.