IS ASPIRIN THE WORLD’S GREATEST ANTIAGEING PILL?

Should we be doing what thousands of people around the world do every morning when they wake up? They rise and swallow what some call the greatest anti-ageing pill of the century.

This small pill offers some protection from heart attacks, thrombosis, colon cancer and, perhaps, prostate cancer and stroke. It may also offer some protection against diabetes and gastric cancer and provide relief from pain, sore joints and even a hangover.

This small pill is not only cheap, but it is also available over the counter.

It is the humble aspirin.

More than 100 billion aspirins are taken worldwide every year, and since it was first commercially produced in the 1890s, the success of aspirin has been unrivalled.

It had a few knocks along the way, endured occasional patches of bad publicity and was a little thrown by the development of competitors such as paracetamol and ibuprofen, but it survived and today is almost the gold standard for medicines.

Aspirin, however, has a dark side. In high doses it has been linked to gastrointestinal ulcers, cerebral haemorrhages and ringing in the ears. It can be harmful to asthmatics and has been associated with an increased incidence of some cataracts.

The drug’s manufacturers warn healthy people against taking a pill every day, just to be on the safe side. Yet some doctors not only recommend taking aspirin daily but take it themselves. Among middle-aged people there is already a trend towards taking an aspirin a day.

Is it safe? For certain groups of men it probably is. Those who stand to benefit most are those who have already had a heart attack, a mini-stroke or a full stroke or are at high risk of these events. A daily aspirin can reduce the likelihood of a second of these events by 25 to 30 per cent. Given that aspirin is so cheap and available, this is a most respectable benefit.

Reputable studies have shown that if those men who have no cardiovascular symptoms take an aspirin a day it will offer them marginal protection against an event. It does however, increase their chance of having a cerebral haemorrhage (a bleed into the brain).

Aspirin makes the platelets in the blood less sticky and less able to form clots. Normally when a blood vessel is damaged platelets rush to the area, combine with other blood components to form a plug and release substances to encourage the wall of the vessel to contract.

If the platelets have lost their stickiness, they cannot do this efficiently. It takes a week for them to regain stickiness.

Some groups of men should not even think of taking a daily aspirin without their doctor’s permission. Among these is anyone with a history of ulcers or abnormal kidney function, anyone suffering from a bleeding disorder or asthma and anyone with high uncontrolled blood pressure.

It used to be thought that aspirin protected against cataracts but a large study in the Blue Mountains in New South Wales found the contrary to be true. It found that people who used aspirin for 10 years or more had a higher prevalence of posterior subcapsular cataracts than nonusers and short-term users.

However, doctors warned people that the benefit of aspirin to those at risk of a cardiovascular event outweighed the risk of cataracts. Compared to a stroke or heart attack, a cataract is a minor problem that can be successfully treated with surgery in 99 per cent of cases.

When trying to decide whether or not to take aspirin, the risk-benefit ratio must always be analysed. Consider, for example, the drug’s effects on the gastrointestinal tract. In the long term, aspirin has been shown to be protective against colon cancer. Some studies say that people who take aspirin regularly have a 40 per cent lower risk of developing this cancer than the general population. One study of women who took aspirin for more than 20 years put the risk reduction at 50 per cent.

But aspirin causes damage higher up the tract. It can corrode the lining of the stomach, which often leads to slight blood loss. It can also aggravate existing ulcers.

Taken daily, aspirin can lead to the formation of ulcers and complications such as internal bleeding and perforation. Even small doses can hurt. To try to overcome this, a specially coated pill has been manufactured to prevent the aspirin being released in the stomach. It passes through and is released lower down the intestines where it is absorbed gradually into the bloodstream. Despite this the aspirin can still reach the stomach.

The risk of adverse effects from aspirin depends on the dose: the smaller the daily dose, the smaller the risk of problems. In clinical trials before 1985, enormous doses of 500 mg to 1500 mg a day were evaluated. Today it is known that the cardiovascular benefit can be achieved with doses of 75 mg to 150 mg daily. This is best achieved by taking either a single 100-mg tablet or half a 300-mg. If cost is not a consideration, the best option is a low-dose coated pill.

Aspirin keeps on turning new tricks. It has been the miracle drug of the century and shows no sign ofletting up. It is claimed that one scientific paper on aspirin is published somewhere in the world every 2 hours.

If you are a cautious soul and don’t want to risk an aspirin a day, you could try wearing them instead. In the 1980s, Burmese mountain people were seen wearing chains of neatly threaded aspirins around their necks as amulets against pain and disease -surely that can’t hurt.

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