The Aspirin Myth -- Does it Really Help You?
Over 10 percent of patients who take low-dose aspirin to ward off a heart attack develop peptic ulcers, which often have no symptoms.
This was the finding of researchers from the University of Western Sydney in Australia. Using endoscopy, they studied 187 patients who had been taking between 75 milligrams and 325 milligrams of aspirin daily for at least one month.
An Annual Ulcer Rate of 28 Percent
The researchers found that 10.7 percent of patients in their study developed ulcers at least 3 millimeters in diameter. However, only 20 percent experienced symptoms that were significantly different from patients with no ulcers, which means many people may not know the ulcers exist.
After three months, the endoscopy was repeated among the 113 people who did not have ulcers when the study began. It was found that:
Over 7 percent had developed an ulcer during this period
This boosted the annual ulcer rate to 28 percent
Other factors that increased the risk of developing ulcers included being 70 years of age or older or having a bacterial infection with H. pylori.
The researchers said the benefits of using aspirin should be carefully assessed before those who have low cardiovascular risk take it for a long-term period.
Alimentary Pharmacology and Therapeutics November 2005, Volume 22, Page 795
Yahoo News December 12, 2005
Dr. Mercola's Comment:
Aspirin has developed a reputation in conventional medical circles for being a useful approach for lowering the risk of heart disease -- just take one a day to prevent heart attack or stroke.
Although, let's not forget that aspirin is in fact a drug.
Once you understand natural medical principles it is easy to see that any drug is not the solution for a chronic degenerative disease. Although it may seem to provide some initial benefit, the long-term overall view is rarely appreciated, as it nearly invariably shows a combination of side effects that far outweighs any benefit.
The case of Vioxx is quite clear. Tens of thousands of people around the world paid the price with their lives for choosing some temporary pain relief in exchange for a fatal heart attack.
In the case of aspirin, if you read the studies by British and American researchers, you will see that taking aspirin can cause much more harm than good.
The chance of developing ulcers is just one potential side effect. Others include:
Increasing your risk of pancreatic cancer
Damaging your kidneys
The best alternatives to aspirin? Simple lifestyle changes such as taking fish oil and exercising can have a tremendously positive effect on your cardiovascular system.
Nattokinase is a fibrinolytic (breaks up fibrin, which is found in clots) enzyme made from fermented soybeans. It is comparable to aspirin in its beneficial effects on your blood, but without any side effects.
Using Nattokinase in combination with appropriate lifestyle and dietary modifications can provide excellent protection from heart attacks and many other forms of heart disease.
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Aspirin Dangerous and Ineffective for People With Heart Failure
People who are diagnosed with heart failure and follow a treatment regimen that includes blood thinners such as aspirin or coumadin could be putting their health into more danger.
Researchers stated that just because heart failure patients stand a greater chance of experiencing a heart attack or stroke doesn't automatically make them appropriate candidates for antithrombotic therapy.
Study Comparing Blood-Thinning Therapies to no Antithrombotic Therapy
Participants included 279 patients who were diagnosed with heart failure that required diuretic therapy
Participants were divided into three groups, aspirin therapy, warfarin therapy and no antithrombotic therapy
Results of the Study
Aspirin and warfarin didn't provide the patients with any valuable health benefits
There didn't appear to be any substantial differences of incidences of death, nonfatal heart attacks or nonfatal stroke in the three groups of the study
Patients in the aspirin group had increased chances of experiencing serious gastrointestinal problems
Cases of minor bleeding complications were primarily seen among the aspirin and warfarin group
Patients in the aspirin therapy group were twice as likely as the patients in the warfarin group to face hospitalization for cardiovascular complications, particularly worsening cases of heart failure during the first 12 months following the study
Based on the results from this study, experts said that treatment of heart failure involving a multitude of drugs that proved to be ineffective should be eliminated as a treatment option.
American Heart Journal July 2004;148(1):157-64
Dr. Mercola's Comment:
Using aspirin for heart disease has been controversial for years, and now aspirin is in the news again.
A better and safer option than aspirin is Nattokinase, a powerful enzyme -- derived from the food natto -- that can dissolve blood clots and has been used safely for over 20 years.
Rivaling pharmaceutical agents, Nattokinase seems to have longer lasting beneficial action without the potential for abnormal bleeding. For an all-natural source of this healthy enzyme, try Serracor-NK, which contains 15,000 Fibrinolytic Units (other products typically contain no more than 1,000-2,000 FU's) and is certified free of genetically modified organisms.
Aspirin Not Recommended for Heart Disease Anymore
By Dr. John G F Cleland
Despite the vast size of these meta-analyses, the evidence in support of aspirin preventing atherosclerotic events is still inconclusive.
The third meta-analysis from the Antithrombotic Trialists' Collaboration contains data on over 100,000 patients at high risk of atherosclerotic events, representing more than 250,000 patient years of follow up.
This meta-analysis and its predecessors form the major argument for the current widespread fashion of prescribing aspirin to such patients. It is an enormous body of research and the collaboration is to be congratulated for having gathered so much data. However, quality as well as quantity matters. And the quality is such that the results can only be inconclusive.
The series of meta-analyses on the antiplatelet activity of aspirin overvalues aspirin's effectiveness and safety
All the large long term trials of aspirin after myocardial infarction show no effect on mortality
Aspirin may change the way vascular events present rather than prevent them
This may lead to a "cosmetic" reduction in non-fatal events and an increase in sudden death
Data on the safety and cost-benefit of aspirin are inadequate
Advocating the use of aspirin for preventing atherosclerotic events diverts attention from other, more effective, drugs
Trials Do Not Show That Aspirin Saves Lives
Meta-analysis is increasingly viewed either as a way of verifying that the outcome of an individual trial is consistent with the rest of the known data or as a way of generating a hypothesis.
However, in the absence of a definitively positive trial, many consider meta-analysis inadequate evidence for clinical decision making. The series of meta-analyses from the trialists' collaboration contains serious additional flaws.
It is remarkable and probably statistically significant how seldom trials of antiplatelet agents have shown benefit on their selected primary outcome. The choice of the primary endpoint by the Antithrombotic Trialists' Collaboration is arbitrary and suspect.
Antiplatelet agents seem to be substantially more effective in reducing the incidence of non-fatal events than in reducing death. Indeed, among large long-term trials after myocardial infarction there is no evidence that aspirin saves lives.
An intervention can reduce non-fatal events in three ways: by genuinely reducing them, by concealing them, or by converting non-fatal events into fatal ones.
The failure of aspirin to reduce mortality despite a reduction in non-fatal events in many studies suggests that aspirin may conceal, rather than prevent, vascular events.
Epidemiological data suggest that 25% of non-fatal myocardial infarctions are silent. As aspirin, even at low doses, is an analgesic and because it may provoke dyspepsia, which may create confusion about the cause of chest pain, it is not difficult to believe that aspirin could increase the proportion of silent events from 25% to 30%. This could explain all the benefits of antiplatelet agents on non-fatal myocardial in the meta-analysis.
Aspirin increased the risk of sudden death in every long-term study after myocardial infarction that reported such events.
This increase was from 4.4% on placebo to 5.6% on aspirin in the persantine-aspirin reinfarction (PARIS) study; from 2.0% to 2.7% in the aspirin myocardial infarction study (AMIS); and from 2.0% to 2.4% in the persantine-aspirin reinfarction study (PARIS-II).9
This could reflect an increased risk of sudden death among concealed, and therefore untreated, events. Another possible mechanism by which aspirin may convert non-fatal events into fatal ones is by increasing the risk of hemorrhagic conversion of cerebral and myocardial infarctions.
All cause mortality and, arguably, disabling stroke are the only robust markers of benefit with an antiplatelet agent. It is not clear that antiplatelet agents reduce the risk of either.
Some trials that were included lost more than a quarter of their patients to follow up. In similar circumstances, with other agents, it has been suggested that all patients lost to follow up in the active treatment group should be considered to have died and none of those in the control arm. Such an analysis would neutralize the benefit observed in one of the few seemingly convincingly positive studies of aspirin, the ISIS-2 trial.11
Bias In Interpretation
The Antithrombotic Trialists' Collaboration shows bias in the analysis and interpretation of their results. We are given scant detail on how the numbers of events credited to each trial changed between meta-analyses. Trials were retrospectively reanalyzed, resulting in resurrection of a number of apparently dead patients and the discovery of a number of new deaths.
Most interventions probably help some people some of the time and harm others some of the time. A small benefit could reflect a small overall benefit in a large population or a substantial benefit in some patients and harm in others.
Aspirin could exert a short-term benefit followed by long term harm, in which case the benefits and safety of aspirin could be increased by using only a short term course of therapy. Aspirin may be harmful in patients with coronary disease and heart failure.
The evidence for an adverse interaction between aspirin and angiotensin converting enzyme inhibitors observed in the SOLVD (studies of left ventricular function) and HOPE (heart outcomes prevention evaluation) trials is also a matter for concern. These are important issues that have not been adequately addressed.
Neither Safe Nor Cheap
Many believe that, even if aspirin is not effective, it is safe. Aspirin does appear to be relatively safe for the patients included in clinical trials, but as these studies excluded by design patients at risk of adverse events with aspirin and tended to include younger patients with lower multiple morbidity it is likely that aspirin is not as safe as suggested.
Low dose aspirin for cardiovascular prophylaxis may account for more than 30% of all major gastrointestinal hemorrhage in patients aged over 15, and may also be associated with an increased risk of renal failure.
Finally, there is a widespread view that aspirin is cheap. However, when evaluating the costs of treatment the amount and type of benefit and the costs of managing adverse effects also need to be evaluated. Very few economic appraisals of aspirin have been done.
One such analysis, recently commissioned by the chief scientist's office in Scotland, suggested it may cost more than £80 000 to prevent one event with aspirin for primary prevention and more than £3000 for secondary prevention. These analyses have assumed that aspirin is as effective as the meta-analyses suggest, which may not be true.
Perhaps the greatest potential detriment of aspirin on health care, however, is that it diverts attention away from treatments that are of unequivocal benefit to many groups of patients.
The reader should not accept the conclusions of the Antithrombotic Trialists' Collaboration uncritically but rather read the original papers on which their conclusions are based.