Stopping Aspirin

Every time we pop a pill we put our health at risk. Whether it is a prescription medication, an alternative supplement, or an over-the-counter remedy that we take to feel better, the pill can hurt instead of help us.

Every pill that does anything good for us can pack a surprise. These unintended side effects range from the unpleasant to the deadly.

Ever see an ad for a pill that “has no side effects”? These ads are a dead giveaway that they are either lying or that the pill has no effects. These are the only pills that may be safe — although we certainly would also be wasting our money.

Because of the risks inherent in taking any pill, I keep paring down the contents of my pill boxes. While I don’t need any diabetes drug any more, I still need to take a couple of prescriptions for my enlarged prostate (BPH). My alternative supplement list keeps shrinking, but it is still too long to make me happy. And until recently I made sure to take the most common over-the-counter pill ever.

That pill is aspirin. I took a baby aspirin every morning for at least the past decade. It is an essential part of the “Harvard Cocktail.”

Six years ago I recommended that everyone with diabetes take their daily aspirin. “For just three cents per day you can take a well-tested drug that will significantly reduce your risk of heart attacks and strokes,” I wrote in an article for the LXN Corp. newsletter. “Yet fewer than one of five adults with diabetes take this drug regularly.”

It turns out that the holdouts were generally right and that all the so-called experts were wrong. That’s the good news this week.

Many of us — but not all (see below) — can dispense with aspirin.

We won’t be saving any big amount of money by banishing aspirin from our pill boxes. But just like any other pill that can do some good, it can also do some bad.

Aspirin is far from being benign. Namely, aspirin can cause gastrointestinal bleeding. And the longer we use aspirin and the older we get this risk rises. It is one of the ten drugs that people in the United Kingdom report most often to the Commission on Human Medicines, according to England’s leading medical journal, BMJ, which used to be the abbreviation for the British Medical Journal.

And now this prestigious journal just on Saturday published a huge study of 1,276 people who have either type 1 or type 2 diabetes and were 40 or more. The people they studied also had an acceptable ankle brachial pressure index of 0.99 or less and no symptomatic cardiovascular disease.

This study was a randomized, double blind, placebo controlled trial involving 16 hospital centers and 188 primary care groups in Scotland. Led by Dr. Jill Belch, professor of vascular medicine at the University of Dundee, and fully 25 other co-authors, the full-text of the study is online.

The study concluded that people with diabetes should not take aspirin to prevent heart disease and stroke. “This trial does not provide evidence to support the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied.”

But, people with diabetes should still take aspirin “for secondary prevention of cardiovascular disease.”

Secondary prevention means people who already have an established history of heart disease, stroke, or limb arterial disease, as an accompanying editorial by William R. Hiatt, professor of medicine at the University of Colorado’s School of Medicine, makes clear. “The use of aspirin for secondary prevention of cardiovascular events in patients with coronary or cerebrovascular disease is well established and is based on extensive evidence from the “Antithrombotic Trialists’ Collaboration.”

Nowadays with all the exceptions to the rules we are learning about, some people are throwing up their hands in frustration with the complexity of what’s best for us. I disagree. As the medical establishment fine tunes recommended treatment for diabetes, health disease, and other conditions, medicine empowers us to take better control of our health.

And, sometimes, as with aspirin for most of us, with fewer pills.

This article is based on an earlier version of my article published by HealthCentral.