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Aspirin over the counter? Benefits, risks almost same

Dubai - The notion has been controversial, and the medical advice mixed.

While aspirin might ward of heart disease, it may cause bleeding in other parts of the body since it is a blood thinner, said doctors, adding that no medicine should be taken over the counter.
The notion has been controversial, and the medical advice mixed. A review of scientific data on the topic showed that any benefits are slight, and are counterbalanced by a matching rise in bleeding risks.
Aspirin is a blood thinner and can help prevent clots that may lead to heart attack or stroke. But aspirin also boosts the risk of haemorrhage in the brain, stomach and intestines.
"When considering the totality of evidence, cardiovascular benefits associated with aspirin were modest and equally balanced by major bleeding events," said the report in the Journal of the American Medical Association.
The meta-analysis examined 10 prior studies involving a total of more than 164,000 people with an average age of 62.
Comparing aspirin users to those who don't take aspirin, researchers found "significant reductions" in strokes, heart attacks and deaths from cardiovascular disease among those who took aspirin.
Aspirin use was also linked to an increased risk of "major bleeding events compared with no aspirin," it said. Statistically, the benefits were close to the risks.
Dr Sanjay Rajdev, consultant in interventional cardiology, NMC Specialty Hospital, Abu Dhabi, said that primary prevention of cardiovascular disease, namely; a heart attack (myocardial infarction), stroke and cardiovascular death is an area of controversy.
"Being a cardiologist, I see patients daily taking their aspirin prescription therapy and most of them do well." However, the underlying benefit is derived largely out of their clinical high-risk substrate.
"Many such patients have received either stents or bypass surgery, many have suffered heart attacks and several of them suffer from either a stroke or peripheral vascular disease. Their inherent risk for adverse cardiovascular events is so high that they by default benefit from the blood thinning induced by aspirin," explained the doctor.
"What is however under-recognised is the bleeding potential of baby aspirin.
While the bleeding risk is justified in a large cohort of sick people who tend to benefit, and benefit more using aspirin, than if they were not to take it. The same philosophy cannot be applied to a general section of population whose risk of ischemic events is much lesser as compared to those with overt or manifest cardiac or vascular disease," said Dr Rajdev. 
Roughly, the bleeding risk and reduction of ischemic risk is the same. "Hence it is imperative, we select a population which is programmed to benefit by reduction of ischemic events. For this reason, it would be counter-productive to give a mass prescription of aspirin," he explained.
"Another risk factor where we can get liberal giving aspirin is diabetes mellitus. If a patient is diabetic over 60 years with one or more additional risk factors, primary prevention is appropriate." 
Dr Rajdev said that an area of uncertainty lies in understanding completely the plaque burden inside the coronaries and outside in asymptomatic general section of the population.
"Until this happens, the decision to consume aspirin for primary prevention depends on underlying ischemic heart disease risk, the higher the risk, the more justifiable is the use of aspirin for primary prevention," he said.
Heart disease is the top killer of people worldwide, taking 17.9 million lives around the planet each year, for one-third of all deaths, says the World Health Organisation. Cardiovascular disease remains the leading cause of death in the UAE, accounting for over two-thirds of all deaths.
Sean Zheng, a cardiologist at King's College Hospital and lead author of the JAMA report, said that the public may not understand that taking low-dose, or baby aspirin, carries significant risks. The study also delved into aspirin's preventive benefits when it comes to cancer, and found "no overall association between aspirin use and incident cancer or cancer mortality".
Dr Layla Al Marzooqi, specialist cardiology at Al Zahra Hospital, Dubai, said: "No one should start taking any regular medicine without consultation with a physician. Aspirin can be taken occasionally for pain (for headache for example) or fever for short period but not on a regular basis without doctor's advice, she said.
Dr Layla said that there are many studies from different countries around the world about the benefits and risks of taking aspirin in healthy people.
"Some are pro taking aspirin in healthy people and others are not. I support not taking aspirin prophylactically in heathy people," she added.
asmaalizain@khaleejtimes.com