Aspirin is a well-renowned drug that has been frequently used in treating a wide variety of symptoms. This is due to aspirin being an analgesic, antipyretic and an anti-inflammatory drug, therefore allowing it to undergo numerous courses of action (Ecotrin®, 2017). In particular, aspirin works to prevent myocardial infarctions by reducing the production of thromboxane which is a chemical that makes platelets sticky. The decline in thromboxane causes an antiplatelet effect, making the red blood cells less sticky. So it is less likely for a blood clot to form and block an artery (nhs.uk, 2016). However, its effectiveness has often come in to question, as many wonder whether the drug is doing more harm than good. Although Aspirin has been acknowledged for significantly reducing the risk of heart attacks, it has also increased the risk of severe side effects, such as internal bleeding. This essay will explore both the negative and positive implications of taking a daily dose of aspirin as a treatment for cardiovascular disease.
There is an ongoing controversy regarding the appropriate dosage of aspirin as some researchers argue that those who do not suffer from heart disease but take regular treatment of aspirin is not only ineffective but can be very harmful, while others argue the contrary. This is supported by the contrasting arguments between the U.S Preventive Service Task Force (USPSTF) and the Food and Drug Administration (FDA). The USPSTF claim that aspirin should be administered in low doses for the primary prevention of cardiovascular disease as it can significantly reduce the risk of a cardiac episode for those who are at a genetic vulnerability (Uspreventiveservicestaskforce.org, 2017). However, after carefully examining scientific data from major studies, the FDA has concluded that there is no evidence to support the use of aspirin as primary preventive medication by people who have not previously suffered from a heart attack (Fda.gov, 2017). Therefore, the benefits of using the drug in this manner have not been established, making the risks more prominent. This is due to clinical data almost always showing that a daily dose of aspirin can help prevent reoccurrence in people who have previously experienced a heart attack or stroke, not for those at an increased risk. It is reasonable to suggest that aspirin may be useful as a secondary prevention rather than a primary prevention due to its harmful side effects.
It can be argued that the side effects of taking aspirin simply outweigh the benefits of it due to the risk of an adverse effect on the patient. Researchers have found that taking the drug can increase the possibility of developing gastrointestinal bleeding. It is commonly assumed that low doses of aspirin, such as 75mg per day, will carry less risk of side effects as compared to the higher 300mg doses used in the past. However, it was found that low doses are just as much likely to cause gastro internal bleeding than high doses. This is supported by a meta-analysis that Yoon Kong Loke, MBBS, and Sheena Derry, MBBS, of the department of clinical pharmacology at the University of Oxford conducted. They found that in 24 different studies, including 66,000 subjects, the use of aspirin at relatively low doses was linked to gastrointestinal bleeding (WebMD, 2017). This suggests that consuming the drug could make the patient more susceptible to bleeding complications, therefore questioning how effective it would be to prescribe a healthy patient aspirin as it may make matters worse by introducing the patient to new health conditions in which they have never suffered from before. It could be implied that administering the drug to a patient is unethical as they are fully aware of the adverse consequences it could have on the person. To avoid this ethical issue, the patient must be fully informed of all the side effects and the potential harms of taking aspirin.
Although gastrointestinal bleeding can be critical, it can be prevented. It is possible for a healthy patient to continue taking aspirin without it causing any harm, as long as they are vigilant and aware of any changes in their body. This includes having the knowledge of the key symptoms you are likely to develop with internal bleeding, such as fatigue, weakness and shortness of breath (John P. Cunha, 2017). This helps to prevent any serious side effects as the patient can quickly identify the symptom and visit the doctor before it becomes life-threatening. Therefore, reducing the level of harm towards the patient, while keeping them protected from the risk of a myocardial infarction or a stroke. In addition, the U.S Preventive Service Task Force has claimed that those aged from 50-69 are not at risk from internal bleeding. However, they are at a 10% increased risk of a heart attack or a stroke within the next ten years. (Mayo Clinic, 2017). So it would be effective for those individuals to take a daily dose of aspirin as it could possibly save their life as they would not be susceptible to the most serious side effect.
In any treatment, it is essential to assess the individual baseline risks and to carefully balance this with the side effects of the therapy, in this case bleeding. The ability of an inexpensive drug to prevent serious cardiovascular events is monumental. Therefore, tailoring aspirin therapy according to baseline risk has been proposed as the best practical guidance. The risks can be assessed by examining the history of the patient and whether they are at a higher chance than others to develop internal bleeding. If it is concluded that the benefits of taking aspirin outweigh the risks, it would be effective to take. Fiscella et al. discovered that aspirin was recommended for 34 and 42% of eligible men and women. This may not be a high percentage but it is still showing that the drug’s hazards can be overshadowed by the benefits if the risks are clearly examined. This is further supported by a meta-analysis conducted by Bartolucci et al. He found that aspirin significantly decreased the risk of total cardiovascular events (Nansseu and Noubiap, 2017). This suggests that when used in the correct manner, aspirin can be very beneficial and could potentially save peoples lives.
Furthermore, the intake of aspirin could potentially lower the risk of colorectal cancer, which is a type of cancer that begins in the colon or the rectum. It works by acting on the biochemical pathway that tumours need to grow. Despite increasing efforts worldwide to develop effective prevention strategies, 600,000 people die of colorectal cancer each year (CV, 2017). Recently, it has been recognised that a daily dose of aspirin is associated with a lower risk of cancer death. This is supported by an early analysis of 662,424 men and women, who had enrolled in the U.S Cancer Prevention Study. This group showed that aspirin use at least sixteen times per month was linked to a 40% reduced risk of colon cancer mortality over a 6-year period (Chubak et al., 2017). In addition, studies have also been conducted to show the reduced risk of developing cancer in the first place. In one investigation two large cohort studies were analysed; the Nurses’ Health Study and Health Professional Follow-up Study. It was found that there was a 19% decreased risk of colorectal cancer. Among individuals aged over 50, regular aspirin could prevent 33 cases of colorectal cancer for those who have not undergone a lower endoscopy and 18 colorectal cancers for those who have (Cao et al., 2017). Similar studies have been conducted giving consistent results which improves the validity of this claim. Therefore, it can be assumed that there is a direct link between the use of aspirin and colorectal cancer. So it may be argued that the use of aspirin could be beneficial to healthy people as they are more protected from the rest of the population from developing colorectal cancer.
On the other hand, it can be argued that once a patient starts taking aspirin, they would not be able to stop their course due to the negative consequences. According to a large scale, observation study, the risk of cardiovascular events rises soon after discontinuation. This study involved investigators examining Swedish national databases to form a cohort of approximately 600,000 users of low-dose aspirin for primary and secondary prevention between 2005 and 2009. In particular, 46% used aspirin as a primary prevention due to a family history of cardiovascular disease. It was found that almost 63,000 cardiovascular events occurred during a median follow-up of three years. In addition, patients who discontinued the drug had a 37% higher risk of cardiovascular events. There is a risk of hypercoagulability, which could cause platelet aggregation, leading to the formation of a thrombus (Jwatch.org, 2017). This illustrates a clear correlation between discontinuing aspirin and the increased risk of a heart attack, implying that it may be more likely to suffer from a cardiac event after stopping the drug. This questions whether it would be effective to begin the course as the health risks of discontinuing could be greater than the initial risk of a heart attack.
Although aspirin has a well-established role in reducing the risk of a patient suffering from a cardiovascular event, its benefits for patients who have not suffered from cardiovascular disease remains unclear. Current research has provided an insight into the risks of using aspirin, particularly internal bleeding, compared with its benefits in primary prevention. Although aspirin is inexpensive, there is a lack of evidence supporting the use of aspirin for primary prevention as the benefits do not seem to outweigh the direct risks. Therefore, the decision to initiate aspirin therapy should be judged individually as it must be tailored to the patient in order to reduce their risk of cardiovascular disease. The absolute benefit of reducing the risk of a first cardiovascular event must outweigh the absolute risk of internal bleeding. Additionally, patients’ preference must be considered when making the decision as it would be unethical to not allow them the right to make a fully informed decision regarding their own health. Therefore, it is reasonable to suggest that aspirin may be more effective as a secondary preventative rather than a primary preventative.