{"id":4742,"date":"2016-10-20T23:42:13","date_gmt":"2016-10-20T23:42:13","guid":{"rendered":"https:\/\/aspree.org\/aus\/?p=4742"},"modified":"2021-08-02T08:46:44","modified_gmt":"2021-08-02T08:46:44","slug":"aspirin-overview-history-use-secondary-prevention-and-primary-prevention","status":"publish","type":"post","link":"https:\/\/aspree.org\/aus\/aspirin-overview-history-use-secondary-prevention-and-primary-prevention\/","title":{"rendered":"Aspirin overview: history, use, secondary prevention and primary prevention"},"content":{"rendered":"\r\n<div id=\"toc_container\" class=\"no_bullets\"><ul class=\"toc_list\"><li><a href=\"#Weekly_Dose_aspirin_the_pain_and_fever_reliever_that_prevents_heart_attacks_strokes_and_maybe_cancer\">Weekly Dose: aspirin, the pain and fever reliever that prevents heart attacks, strokes and maybe cancer<\/a><\/li><li><a href=\"#How_does_it_work\">How does it work?<\/a><\/li><li><a href=\"#History\">History<\/a><\/li><li><a href=\"#Aspirin_and_cancer\">Aspirin and cancer<\/a><\/li><li><a href=\"#How_is_it_used\">How is it used?<\/a><\/li><li><a href=\"#Who_shouldnt_use_it\">Who shouldn\u2019t use it?<\/a><\/li><li><a href=\"#How_much_does_it_cost\">How much does it cost?<\/a><\/li><li><a href=\"#Other_points_of_interest\">Other points of interest<\/a><\/li><\/ul><\/div>\n<h1 class=\"wp-block-heading\"><span id=\"Weekly_Dose_aspirin_the_pain_and_fever_reliever_that_prevents_heart_attacks_strokes_and_maybe_cancer\">Weekly Dose: aspirin, the pain and fever reliever that prevents heart attacks, strokes and maybe cancer<\/span><\/h1>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/141186\/original\/image-20161011-3894-d6qg3p.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\" alt=\"\" \/>\r\n<figcaption><em>Aspirin has an extraordinary history that involves many different discoveries around its many different effects. from shutterstock.com<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/theconversation.com\/profiles\/andrew-tonkin-13124\" target=\"_blank\" rel=\"noreferrer noopener\">Andrew Tonkin<\/a>, <em><a href=\"https:\/\/theconversation.com\/institutions\/monash-university-1065\" target=\"_blank\" rel=\"noreferrer noopener\">Monash University<\/a><\/em><\/p>\r\n\r\n\r\n\r\n<p>Aspirin is, <a href=\"https:\/\/theconversation.com\/weekly-dose-ibuprofen-just-because-its-freely-available-doesnt-make-it-safe-56346\" target=\"_blank\" rel=\"noreferrer noopener\">like ibuprofen<\/a> and Voltaren (diclofenac), a <a href=\"https:\/\/www.betterhealth.vic.gov.au\/health\/conditionsandtreatments\/medications-non-steroidal-anti-inflammatory-drugs\" target=\"_blank\" rel=\"noreferrer noopener\">non-steroidal anti-inflammatory<\/a> drug (NSAID) used to treat pain and reduce fever.<\/p>\r\n\r\n\r\n\r\n<p>What makes aspirin different from other NSAIDs is its ability to thin the blood, and it is used to prevent blood clotting in those at risk of heart disease and stroke. Recently, it has also shown potential to reduce the risk of some cancers.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/141337\/original\/image-20161012-8389-1feja4k.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\" alt=\"\" \/><\/figure>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"How_does_it_work\">How does it work?<\/span><\/h2>\r\n\r\n\r\n\r\n<p>Aspirin works by <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14592543\" target=\"_blank\" rel=\"noreferrer noopener\">inhibiting an enzyme called cyclooxygenase<\/a>, which generates prostaglandins. These are in turn associated with inflammation, pain and fever.<\/p>\r\n\r\n\r\n\r\n<p>Through the same enzyme, aspirin also inhibits the production of substances called thromboxanes. These are responsible for the aggregation of platelets in the blood, a process needed to stop bleeding. This is what we mean when we say aspirin \u201cthins the blood.\u201d<\/p>\r\n\r\n\r\n\r\n<p>The mechanism whereby aspirin might be protective against cancer is not fully understood but certain <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4786609\/\" target=\"_blank\" rel=\"noreferrer noopener\">genetic and other characteristics<\/a> may identify those who might particularly benefit.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"History\">History<\/span><\/h2>\r\n\r\n\r\n\r\n<p>In the 16th century BC, <a href=\"https:\/\/books.google.com.au\/books\/about\/Ancient_Egyptian_Medicine.html?id=WHfEnVU6z8IC&amp;redir_esc=y\" target=\"_blank\" rel=\"noreferrer noopener\">Egyptians documented on papyrus<\/a> that the bark and leaves of willow and related plants had pain-relieving and anti-inflammatory properties. The Greek physician Hippocrates later <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_aspirin\" target=\"_blank\" rel=\"noreferrer noopener\">noted these same properties<\/a> in the 5th century BC.<\/p>\r\n\r\n\r\n\r\n<p>Aspirin\u2019s more recent history came from purifying salicylate, the active component in ancient preparations. In 1897, this culminated in the <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1119266\/\" target=\"_blank\" rel=\"noreferrer noopener\">development of acetylsalicylic acid<\/a> or aspirin.<\/p>\r\n\r\n\r\n\r\n<p>Today\u2019s interest in aspirin stems largely from the <a href=\"http:\/\/www.nature.com\/nature-newbio\/journal\/v231\/n25\/abs\/newbio231232a0.html\" target=\"_blank\" rel=\"noreferrer noopener\">seminal 1971 publication<\/a> by English pharmacologists <a href=\"https:\/\/books.google.com.au\/books?id=v9AZ76VD7ZYC&amp;pg=PA227&amp;lpg=PA227&amp;dq=Vane+and+Piper+Aspirin&amp;source=bl&amp;ots=RYtUF9Uudc&amp;sig=lQmcimixCjETOCOJDYsXM7GGgEY&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwjN8LnO-tHPAhVW5WMKHRZzBNoQ6AEIMjAD#v=onepage&amp;q=Vane%20and%20Piper%20Aspirin&amp;f=false\" target=\"_blank\" rel=\"noreferrer noopener\">John Vane and Priscilla Piper<\/a>, who discovered its action in inhibiting prostaglandin production. In 1982, Vane shared the <a href=\"https:\/\/www.nobelprize.org\/nobel_prizes\/medicine\/laureates\/1982\/\" target=\"_blank\" rel=\"noreferrer noopener\">Nobel Prize in Physiology or Medicine<\/a> for his work in this area.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image\"><a href=\"https:\/\/images.theconversation.com\/files\/141179\/original\/image-20161011-3903-1edcryn.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/141179\/original\/image-20161011-3903-1edcryn.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\" alt=\"\" \/><\/a>\r\n<figcaption>John Vane Vane shared the [Nobel Prize in Physiology or Medicine for his work on prostaglandins. <a href=\"https:\/\/www.nobelprize.org\/nobel_prizes\/medicine\/laureates\/1982\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Nobel Foundation website\/Screenshot<\/a><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>In 1950, an American general practitioner Lawrence Craven noted that patients who had their tonsils removed and chewed Aspergum (<a href=\"http:\/\/www.drugstorenews.com\/article\/retrobrands-usa-looking-bring-aspergum-back-market\" target=\"_blank\" rel=\"noreferrer noopener\">a gum containing Aspirin<\/a>) experienced severe bleeding. He later said daily aspirin <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17622365\" target=\"_blank\" rel=\"noreferrer noopener\">appeared to prevent heart attacks<\/a> in his patients.<\/p>\r\n\r\n\r\n\r\n<p>Craven\u2019s claims were doubted by fellow doctors because they were not the subject of randomised trials. This was around the time that the importance of blood clots in events such as heart attack was recognised, and methodology that informed the robust design and interpretation of very large clinical trials was developed.<\/p>\r\n\r\n\r\n\r\n<p>These trials included aspirin among the first therapies tested. A <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19482214\" target=\"_blank\" rel=\"noreferrer noopener\">recent overview of such trials<\/a> showed that aspirin, when compared to inactive placebos, reduced serious vascular events such as heart attack and stroke by about 12% in those who had not previously had such conditions, and by about a fifth in those who had experienced them.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image\"><a href=\"https:\/\/images.theconversation.com\/files\/141324\/original\/image-20161012-8411-drlvfy.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/141324\/original\/image-20161012-8411-drlvfy.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip\" alt=\"\" \/><\/a>\r\n<figcaption><em>Craven noted patients who chewed Aspergum experienced severe bleeding. <a href=\"http:\/\/www.drugstorenews.com\/article\/retrobrands-usa-looking-bring-aspergum-back-market\" target=\"_blank\" rel=\"noreferrer noopener\">Drug Store News\/screenshot<\/a><\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>However, the overview also confirmed that benefits came at the cost of severe bleeding (due to aspirin\u2019s ability to prevent clotting) from the stomach and bowel, or resulted in bleeding into the brain.<\/p>\r\n\r\n\r\n\r\n<p>It is now apparent that factors such as advancing age, smoking and diabetes increase not only the risk of heart attack and stroke, but also major bleeding. This means aspirin can\u2019t be prescribed indiscriminately for everyone.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"Aspirin_and_cancer\">Aspirin and cancer<\/span><\/h2>\r\n\r\n\r\n\r\n<p>In 1988, Melbourne surgeon Gabriel Kune reported that aspirin was associated with <a href=\"http:\/\/cancerres.aacrjournals.org\/wp-content\/canres\/48\/15\/4399.full.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">lower rates of bowel cancer<\/a>.<\/p>\r\n\r\n\r\n\r\n<p>Subsequently, trials supported reduced cancer rate and death in those taking aspirin, not only of the bowel but also of some other organ types. However, cancer was not specified as a major outcome of interest at the beginning of these studies, and because of this, was not examined rigorously.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"How_is_it_used\">How is it used?<\/span><\/h2>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/heartfoundation.org.au\/images\/uploads\/publications\/Reducing-risk-in-heart-disease.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Australian<\/a> guidelines for the use of low-dose aspirin to prevent heart events and stroke are clear cut. If aspirin does not cause problems, such as severe bleeding, it should be used life-long in everyone who has experienced heart-related events such as angina, heart attack, coronary bypass surgery and stroke.<\/p>\r\n\r\n\r\n\r\n<p>In those who haven\u2019t experienced these, decisions on aspirin use must be based on weighing up individual risk of bleeding and these events occurring in the future.<\/p>\r\n\r\n\r\n\r\n<p>The latest, authoritative recommendations by the <a href=\"http:\/\/annals.org\/article.aspx?articleID=2513179\" target=\"_blank\" rel=\"noreferrer noopener\">U.S. Preventive Services Task Force<\/a> about prevention of cardiovascular disease and bowel cancer state that for those aged 50 to 69, taking aspirin depends on the estimated risk of events that might be prevented, and also of bleeding and life expectancy.<\/p>\r\n\r\n\r\n\r\n<p>In those aged less than 50, or 70 years or over, there is insufficient evidence to assess the balance of benefits and harms of initiating aspirin use.<\/p>\r\n\r\n\r\n\r\n<p>Present Australian <a href=\"http:\/\/www.cancer.org.au\/wp-content\/pdf\/HealthProfessionals\/ClinicalGuidelines\/ClinicalpracticeguidelinesJuly2008.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">guidelines for the prevention of bowel cancer<\/a> state there is insufficient evidence to recommend aspirin for all people at average risk, and emphasise that <a href=\"http:\/\/www.cancer.org.au\/news\/blog\/prevention\/does-an-aspirin-a-day-keep-cancer-away.html\" target=\"_blank\" rel=\"noreferrer noopener\">diet and lifestyle improvements<\/a>, as well as screening, are effective in reducing risk.<\/p>\r\n\r\n\r\n\r\n<p>However, those with a strong family history of bowel cancer should often be referred for specialist assessment and aspirin might be recommended after genetic testing.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/141340\/original\/image-20161012-8415-1r667mq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\" alt=\"\" \/>\r\n<figcaption><em>For those aged 50 to 69, taking aspirin depends on the estimated risk of events that might be prevented, and also of bleeding and life expectancy. from shutterstock.com<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>The low dose of aspirin typically used is 100mg daily. This is much less than that which might relieve a headache, other pain or fever, and for which paracetamol is generally recommended in the first instance.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"Who_shouldnt_use_it\">Who shouldn\u2019t use it?<\/span><\/h2>\r\n\r\n\r\n\r\n<p>Use of aspirin should be discussed with a doctor as it should not be used in those who have had a previous allergic reaction to aspirin or other NSAIDs, are pregnant or breastfeeding, have bleeding or clotting disorders, active stomach bleeding or a history of previous bleeding after treatment with aspirin, gastritis or an active or previous stomach ulcer, a history of gout, or severe kidney or liver failure.<\/p>\r\n\r\n\r\n\r\n<p>Aspirin should be taken with water, with or without food. Taking an enteric-coated tablet, which is designed to prevent the aspirin from being released in the stomach, decreases the chance of an upset stomach.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"How_much_does_it_cost\">How much does it cost?<\/span><\/h2>\r\n\r\n\r\n\r\n<p>Aspirin is relatively cheap and the cost can range from <a href=\"http:\/\/shop.coles.com.au\/online\/national\/coles-tablets-aspirin-300mg\">A$0.95 for a 24-pack<\/a> of 300mg tablets to <a href=\"http:\/\/www.chemistwarehouse.com.au\/Shop-Online\/723\/Low-Dose-Aspirin\">A$2.99<\/a> for 100 tablets of 100mg.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span id=\"Other_points_of_interest\">Other points of interest<\/span><\/h2>\r\n\r\n\r\n\r\n<p>The ongoing <a href=\"http:\/\/www.aspree.org\/aus\/\" target=\"_blank\" rel=\"noreferrer noopener\">ASPirin in Reducing Events in the Elderly<\/a> (ASPREE) trial, conceived and initiated in Australia, has completed recruitment and is following up more than 16,700 healthy Australians aged 70 years and over, and almost 2,500 people in the United States. It involves more than 2,000 Australian general practitioners as co-investigators.<\/p>\r\n\r\n\r\n\r\n<p>The primary question investigated is whether aspirin improves healthy active life years (time lived free of dementia or physical disability), outcomes fundamentally important to the elderly. This encapsulates the net effect of benefits and risks of aspirin.<\/p>\r\n\r\n\r\n\r\n<p>The trial will also provide unique data concerning whether aspirin prevents cancer in the elderly. It is anticipated that ASPREE\u2019s findings will be reported in 2018.<\/p>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/theconversation.com\/profiles\/andrew-tonkin-13124\" target=\"_blank\" rel=\"noreferrer noopener\">Andrew Tonkin<\/a>, Professor and Head, Cardiovascular Research Unit, <em><a href=\"https:\/\/theconversation.com\/institutions\/monash-university-1065\" target=\"_blank\" rel=\"noreferrer noopener\">Monash University<\/a><\/em><\/p>\r\n\r\n\r\n\r\n<p>This article is republished from <a href=\"https:\/\/theconversation.com\" target=\"_blank\" rel=\"noreferrer noopener\">The Conversation<\/a> under a Creative Commons license. Read the <a href=\"https:\/\/theconversation.com\/weekly-dose-aspirin-the-pain-and-fever-reliever-that-prevents-heart-attacks-strokes-and-maybe-cancer-64440\" target=\"_blank\" rel=\"noreferrer noopener\">original article<\/a>.<\/p>\r\n\r\n\r\n\r\n<p>Andrew Tonkin is a senior investigator to the <a href=\"\/aus\/about-us\/\">ASPREE<\/a> project.<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Read a great overview of aspirin, its history and use in modern medicine, prepared by ASPREE Investigator, Prof Andrew Tonkin. <\/p>\n","protected":false},"author":2,"featured_media":4745,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"1200","footnotes":""},"categories":[17,18,16],"tags":[28,53,55],"_links":{"self":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts\/4742"}],"collection":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/comments?post=4742"}],"version-history":[{"count":6,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts\/4742\/revisions"}],"predecessor-version":[{"id":8309,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts\/4742\/revisions\/8309"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/media\/4745"}],"wp:attachment":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/media?parent=4742"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/categories?post=4742"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/tags?post=4742"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}