An aspirin a day keeps the doctor away article by Doctor Kenneth Prudhoe Club de Mar Medical Centre Palma de Mallorca

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An aspirin a day keeps the doctor away

An apple, or three, a day has been recommended for years as a simple tip for a healthy lifestyle but now aspirin is coming up strongly as a pharmacological fruit to keep the doctor away and disease at bay.

Aspirin was developed by French and German chemists in the 19th century and was eventually launched in 1899, quickly becoming a huge success for the treatment of pain and fever. It dominated the first half of the 20th century and its market share only declined after the launch of paracetamol (US acetaminophen) in 1956 and then further after the launch of ibuprofen in 1969. Paracetamol had the distinct advantage that it does not cause gastric upset and possible stomach bleeds that had dogged aspirin at the adult dose (two 300mg tablets four times daily) needed for control of pain or fever - but aspirin was tolerated when there were no alternatives. Aspirin was further affected when it was confirmed that a tiny number of children suffered brain and liver damage and the regulatory authorities severely restricted the use of aspirin in children so that it is no longer used for children under 16 in the UK

Aspirin's fortunes were revived in the sixties and seventies when it became clear that it had anti-clotting properties at low dose (75mg daily) which reduced blood clots that produced heart attacks and strokes and the unwanted side effect profile was correspondingly reduced at the dramatically lower dose required. Many middle-aged and older people are now taking a 75mg soluble aspirin daily hoping to fend off an unwelcome heart attack or stroke although the evidence, for people without major risk factors like high blood pressure, diabetes, smoking, obesity, lack of exercise, is marginal. The definite benefit is for people who have already had a heart attack or stroke and want to avoid a repeat but the marginal possibility of an otherwise healthy person stopping the very first episode is enough for many to take the plunge and swallow the tablet.

The recent news which tips the balance in favour of a little aspirin a day is that it may also reduce various types of cancer.

A study, covering 25,000 mostly UK patients, published in the Lancet (front-line UK medical journal) in late 2010 by researchers, at Oxford University and other centres, showed that taking a small (75 mg) daily dose of aspirin for between four and eight years substantially reduces death rates from a range of common cancers by at least a fifth and the reduction of risk continued for 20 years in both men and women. For specific cancers the reduction was about 40% for bowel cancer, 30% for lung cancer, 10% for prostate cancer and 60% for oesophageal cancer and reductions in other cancers (pancreas, stomach, brain, breast, ovaries) need further study but this is in progress. The risk of internal bleeding from aspirin remains but the aspirin dose is small and the danger of major bleeding is very low in middle age.

The benefit of healthy adults taking a small aspirin each day to fend off heart attack or stroke has been seen as marginal till now. The recent results on cancer reduction seem to change all that and to tip the balance. It does now seem that this rather antiquated medication has some modern surprises and we might well decide to take one 75mg tablet each day (effervescent to minimise stomach upset, and possibly taken with an apple or, better still, some breakfast) when we have very little to lose and possibly a lot to gain.

Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca. Tel: (+ 34) 639 949 125.