An aspilet a day can keep the doctor away... for some

Q. I know a number of old people who have been advised by their physician to take one tablet of aspirin a day. What exactly is this prescription for? Isn't aspirin against pain and fever only?

A. Aspirin or acetyl salicylic acid is one of the earliest medicines ever used by man, and although it became widely used for fever and pain soon after it was first synthesized by a French chemist, Charles Frederic Gerhardt, in 1853, other important applications of the drug where subsequently discovered. For example, several decades ago, it was found out that, at high doses, it has an anti-inflammatory effect and in time, it became the prototypical drug for a group of substances called nonsteroidal anti-inflammatory drugs (NSAIDs)-drugs with analgesic and antipyretic effects and at higher doses, anti-inflammatory effects, which reduce swelling, pain, tenderness and limitation of joint movement associated with arthritis and injuries.

Aspirin however has some adverse effects and when safer drugs such as paracetamol (acetaminophen) and ibuprofen were released into the market in 1956 and 1969, and the NSAIDs a little later, the popularity of aspirin as an analgesic, antipyretic and anti-inflammatory drug started to wane.

However, in the last 20 years, aspirin has resurged in popularity because in the 1980s, it was established that in amounts that are much lower than its recommended antipyretic and anti-inflammatory dosages, it is an effective anticoagulant or anticlotting agent that reduces the risk of clotting diseases, the underlying causes of many heart attacks and strokes.

At present, daily low-dose aspirin therapy (i.e., 75 or 81 mg) is recommended for two groups of people: those who have had a previous heart attack or stroke, or those who have high risk for either. The latter group includes those who possess the following risk factors associated with heart attacks and strokes: smoking; high blood pressure, high cholesterol levels, poor lipid profile, diabetes, family history of stroke or heart attack, sedentary lifestyle, stress and alcohol consumption amounting to more than two alcoholic drinks for men and one for women. For this group, the recommendation by the U.S. Preventive Services Task Force on the use of aspirin for the primary prevention of coronary heart disease is to encourage men aged 45 to 79 and women aged 55 to 79 to use aspirin when the potential benefit of a reduction in myocardial infarction for men or stroke for women outweighs the potential harm of an increase in gastrointestinal hemorrhage.

Thus, for a certain sector of the society, an aspilet (that is how low dose aspirin preparations are usually called) a day could really keep the doctor away.

Aspirin however will not benefit everyone. It offers no benefit to adults who have low risk for heart attack or stroke. In these people, the chances of other events caused by aspirin's adverse effects outweigh any potential benefit. Aspirin can irritate the stomach, leading to nausea, vomiting, heartburn and persistent stomach pain. Other side effects include ringing in the ears, dizziness, drowsiness, confusion, diarrhea, bleeding, heartburn, indigestion and allergic reactions, which can sometimes be fatal. Aspirin could also damage the kidneys.

By the way, in children and teenagers with fever, especially if caused by viral infection, aspirin has been associated with the development of a potentially fatal condition called Reye Syndrome, a rare but severe illness characterized by acute encephalopathy and fatty liver. For this reason, aspirin should never be given to anyone under 20 who has a fever.

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