Is aspirin a wonder drug?

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

Follow me on Twitter @RobShmerling

Imagine that after years of painstaking research, scientists announced the development of a breakthrough treatment that costs pennies a pill, saves lives, and could reduce healthcare spending by nearly $700 billion in the coming years. And you wouldn’t even need a prescription to get it. Perhaps this all sounds too good to be true. But, according to a new study, we already have such a drug: it’s called aspirin.

An analysis of aspirin use

Based on current recommendations, only about 40% of people who should be taking aspirin are doing so. In this new report, researchers asked: what might happen to population health, longevity, and healthcare costs if aspirin use were more widespread? To answer this, they analyzed reams of health data from thousands of patients and estimated the impact of more widespread aspirin use on their health and survival.

Their findings were striking. For people in the U.S. ages 51 to 79, routine aspirin use could, over a 20-year period:

  • prevent 11 cases of heart disease for every 1,000 persons
  • prevent four cases of cancer for every 1,000 persons
  • lengthen national life expectancy by about four months, allowing an extra 900,000 people to be alive in 2036
  • save $692 billion.

Is there a downside to aspirin?

As is true for all medications, aspirin has its downsides. Among other side effects, allergic reactions may occur. And, aspirin is a blood thinner and can irritate the stomach. Episodes of bleeding and stomach ulcers can be serious. So, the researchers took these into account; the estimates above include these side effects of taking aspirin.

It’s important to emphasize that this study assessed the impact of low-dose aspirin, such as the 85 mg daily dose often found in baby aspirin; higher doses may be recommended for other conditions (and come with added risk). In addition, aspirin can interact with other medications. For example, if you take low-dose aspirin for your heart and ibuprofen for arthritis, it’s important that the ibuprofen be taken at least 30 minutes after or more than eight hours before the aspirin; otherwise, the benefit of the aspirin may be lost.

Who should take aspirin?

For those at highest risk of future cardiovascular problems, including those who have had a prior heart attack or stroke, aspirin is routinely recommended to reduce recurrence.

For everyone else, recommendations vary. Some experts recommend low-dose aspirin for everyone over age 50. Other guidelines make a more conservative recommendation based on age (e.g., 50–79 years old) and cardiovascular risk factors that predict a heart attack or stroke occurring in the next 10 years. Well-studied risk calculators, such as the one developed by the Framingham Heart Study, are available to estimate 10-year risk.

In addition, aspirin is routinely recommended to lower cancer risk in people with certain genetic conditions, including hereditary nonpolyposis colorectal cancer.

Why don’t more people take aspirin?

It’s not entirely clear why many people forego aspirin use. My guess is that it’s a combination of factors, including:

  • a lack of awareness that aspirin is recommended
  • it wasn’t specifically recommended by their doctor
  • a greater concern about side effects from aspirin than its potential benefits
  • a previous bad experience with aspirin use, such as an allergic reaction
  • an aversion to medications in general.

It’s worth emphasizing that when it comes to any treatment — and especially preventive treatments — individual preferences matter a lot. As a result, many reasonable people who would be good candidates to benefit from aspirin will choose not to take it.

What does this mean for you?

For all the effort to identify new and better drugs, it’s remarkable that we aren’t taking full advantage of what we already have. This new study suggests that large health benefits are not being realized simply because not enough people are taking aspirin. But each person has his or her own set of circumstances that can affect the both the risks and the benefits of aspirin treatment, as well as his or her own preferences. The decision to take or forego aspirin is a big one — so add this to your list of things to discuss at your next appointment with your doctor.

Comments:

  1. Carlos Rodriguez

    How about people with G6PD Deficiencies? I was told not to take aspirin but that was over 30 years ago and recommendations can change as history has shown us with other medicines. All I currently take is Synthroid 100mcg and aside from that I’m a healthy 55 year old.

  2. Lyn Landsperger (DO NOT POST NAME)

    I used to take aspirin on a daily basis because I’d get headaches. I generally would take 2 aspirins a day. Every doctor indicated it was fine. The problem was, over a period of a number of years, I developed kidney disease. I now have Stage 3 Kidney Disease. There are only 5 Stages. Aspirin is NOT a wonder drug. You have to be careful. I did not take more than 1000mg daily; most days, it was 500mg. As most people know, a 500mg tablet does not contain 500mg of aspirin. My suggestion is to be careful. Listen to your body and not doctors. DO NOT TAKE ANY MEDICINE. JUST EAT PROPERLY!!!

  3. Grace

    What about Asprin induced asthma? My dad is 88. After taking Asprin for a year, he started to develop wheezing. He is prescribed Asprin just because Canadian doctors prescribe it to every senior. However, my dad goes swimming every day, and eats 8 servings of fruit and veggie each day. He has perfect blood pressure at 120/70. When I heard recently that Asprin could induce asthma and talked to his doctor, she said he could stop. He doesn’t stop, however, because my sister insists that stopping will incur more risks. Should doctors evaluate each patient individually before they prescribe a drug like candy? Every drug has side effect. A healthy life style is the best in prevention.

    • David

      Grace- Canadian Doctors do not give out Asprin to every senior! They follow the same practices that you do in the US.

      • Grace

        My dad’s doctor told me they prescribed Asprin to elderly for prevention, disregard the variation in their health conditions. That’s why she prescribed Asprin to my dad even though he was physically healthy.

  4. Dr G

    You can buy 75mg aspirin in the UK which is specially coated to obviate gastric bleeding – does this not meet the objections from the anti-aspirin brigade? I am not a doctor by the way (well not of medicine!)
    from Dr G

  5. Aubrey Dickman MD

    This well-intentioned article highlights the hazards of writing about complex medical issues for the general public. Reviewing the comments, surely from lay folks, I am reminded of this truism once again. As a Cardiologist, I have read countless articles and studies pertaining to Aspirin. It is hard to synthesize, digest and then even harder to know what advice to dispense to any one specific individual.
    This particular topic could perhaps have been addressed as follows: “Aspirin is a powerful and remarkably inexpensive medication. Discuss with your own physician, whether it is right for you”. As with all drugs, the risk-benefit ratio needs careful consideration by doctor and patient. Even with the best of intentions and carefully thought through discussion, there is a potential down-side. There is obviously also a very real benefit. It is very simply – NOT SIMPLE!!! Like most things medical.

    • VinceMiraglia

      The problem here is to equally trained physicians may have different views of the same fact set. Seems more than lay folk are confused.Perhaps such caution should be exercised on any number of prescription drugs and the medical profession should demand neutral experts not conflicted by ;financial conflicts ; making recommendations.

  6. Sri

    Will taking aspirin every day over long periods of time reduce its effectiveness/benefits ? And so it is recommended to stop taking for some period of time and restart after a break. I thought I read this somewhere. Has anyone heard this anywhere ?

  7. sally

    what about fatty liver heard not good!!

  8. Bob

    I think the highly publicized warnings about children taking aspirin for fear of Rhymes disease did more than anything else to switch people to Tylenol for the rest of their lives. Indeed, fortunes have been made by many companies who produce substitutes for commonly used and trusted food and diet standards of days past.

    A perfect example of this the dairy processing industry, which has been selling fat free milk at basically the same price as whole milk, in spite of the fact that their cost paid to dairy farmers is based directly on the weight of the milk fat delivered in the raw product. Only lately have a few stores like Walmart started selling skim milk at a price somewhat relative to their cost.

    • Maria Jasmine Freeman

      I guess you mean Reye’s syndrome?!
      That was a really scary illness with death or mental deficit complications, that we witnessed as pediatricians, and which indeed almost disappeared with shift to use of paracetamol. Of course this syndrome has its definition, most particularly in presence of a varicella or influenza infection. and overuse of aspirin, especially in children.
      Dr Hana Fayyad, pediatrician ( Maria Jasmine Freeman, published author).

  9. Dan Bender

    I can remember my grandmother who lived in the 1960s with arthritis when there were no other drugs available for. She took 3-5 regular sized, non coated aspirins daily, and somehow survived the ear ringing and other side effects in order to eliminate her joint pain. I am wondering if anyone still takes this high quantity of aspirin now, or has this practice been discarded.
    By the way, my grandmother lived into her 80s, had no heart disease, and apparently no internal bleeding from high dosage aspirin.

    • Vipin Shah

      Every anti inflammatory after Aspirin come with a bag of side effects.
      Unfortunately Aspirin a has been sidelined in arthritis and it should be brought back.

    • Michael

      I take a headache poweder which is a misture of aspirin and paracetamol, and this has no effect on me, except that it takes my “everyday” headache away! I hope that I also have other health benefits from the aspirin intake which is 500mgs daily.

    • Richard Baas

      growing up in 60 people I seen them take half bottle dose for pain no wonder they had stomach trouble!

  10. Kin Thye

    People who are G6PD deficient should avoid taking aspirin. It appears that not many are aware of this medical condition.

  11. peter

    This article is miss leading. For 100 years Aspirin was prescribed just about for everything, even for stomach pain. Doses used to be 300-400 mg and the damaged to stomach was killing people. Even 85 mg is making holes in stomach.

  12. Sue Ma

    My dad had taken aspirin for the last 20 years. He had stomach cancer and passed away last year. There is always a risk to take any medicine. Be very careful to weigh the benefit and risk.

  13. Apolonio F. Marin

    Jan 10,2017
    A. Marin
    It is interesting to listen that aspirin is a wonderful drug, but how it
    work? It is know that aspirin reduce the concentration of blood,
    so in that way it can run more fast and travel the same distance more frequently in the unit of time, as the blood is life and also provide protection to the affected area, that is the way how aspirin work in some cases.

    Reply

  14. Albert

    I wander if ACV or cayenne would have the same benefits.

  15. Sam Grog

    If you read the study, you will see that it’s not convincing. Simulation models have too many limitations.

  16. lanny taylor

    for 4 mo.s more life?????????????

  17. Carol Fosshage

    I’ve been told that because I take Warfarin that I should not take aspirin–I used to.

  18. Nawaz ahmed

    My doctor has prescribe for my heart tricardin caps lowplat concour sustac. Since long I take asprinC effervacent twice daily. The day doctor has added tricardin I feel no heart problem. I am 76 now. Any comments will be helpful.

  19. mike g

    The stats stated are truly abysmal, aspirin it would seem is nearly useless in the stated regards

    prevent 11 cases of heart disease for every 1,000 persons
    prevent four cases of cancer for every 1,000 persons
    lengthen national life expectancy by about four months, allowing an extra 900,000 people to be alive in 2036

  20. Carolyn

    Aspirin would be fine for me—except I am allergic to sodium lauryl
    sulate, phenolglycol, aluminium sulfate and talc. Is this product
    available without these compunding items?

  21. alxzba

    is not aspirin contraindicated for folks who have a history or the possibility of having a stomach ulcer?

  22. Joe Weber

    Here’s another health benefit, albeit minor compared to a heart attack: Whenever I have a scratchy throat or otherwise feel a cold coming on, I immediately take 2 aspirin. Then another 2 pills in 4 hours. That almost always knocks out the cold. The last cold I had was 4 years ago. Admittedly, I did the aspirin thing then as well, but the virus was evidently stronger than the pill. Not much to lose by giving it a shot….next time your throat gets scratchy and you feel a cold coming on.

    • charles wick

      My father, who was a salesman and hence exposed to a lot of colds on his rounds, swore by the same regimen you describe , and he rarely got sick. He gargled with Listerine, took 2 aspirin and said nearly always he was cured.
      I have started to do the same when I feel a cold coming on. Best advice ever.

  23. Shelby Marcus

    I endorse this article. Taken for years now. Only side effect I have is bruising easily.
    I take Lotrel for high BP, but the two do not seem unhappy in my system.
    Shelby Marcus

  24. Victoria

    Hi, I know all so well, why a aspirin a day will and can save your life. Have block arteries with blood flow, has given me two “TIA”. I know the arteries can become unblocked with hard work or treatment, so that living a normal life again. I take a 325mg aspirin first thing in the morning with breakfast, to prevent any stomach issues has been very successful for me. I will continue taking until my arteries are clean and will continuing to take a aspirin for the rest of my life until my doctor tell me otherwise.

  25. Linden Johnson

    My cardiologist advised approx. eight years ago not to take aspirin as he said females were more prone to bleeding than males. Has the latest research changed this advice?

  26. Jenny

    There was an article a couple of yrs ago in the NY Times (https://www.nytimes.com/2014/05/20/opinion/a-cancer-treatment-in-your-medicine-cabinet.html) by researchers who are fighting a battle to research aspirin as a breast cancer treatment.

    They said explicitly that they cannot get money because big pharma cannot make money on something so obviously beyond a patent. Their early findings are about 50% reduction in breast can recurrence – about the same as Tamoxifen and the ‘newer, bigger, better’ (aka money maker), arimidex – both of which have many side effects – some serious.

    Someone fund these aspirin studies and help save lives!

  27. Vince DiGioia

    Well I’ve had two posterior vitreous detachment rihat and left eye and no retina tear nor retina detachment. During even Bp not controlled well. Since the events BP well controlled. Prior to events took 84 mg aspirin, 200 cut E. I now on my own take one half of 84 mg aspirin and no Vit. E, added lutein, bilberry and cooper. Do you think combo habits contributed to PVD and is going half on 84 mg. Good choice or 42mg.

  28. Isabel Sarria

    I have NASH (liver disease) and my doctor asked me to stop taking aspirin. It’s so easy to get confused with all the well-intentioned but conflicting advice from the medical profession. I truly am confused.

  29. Martin Groenewegen

    ASPERINE CAUSES TINNITUS

  30. Dr Shabi Abidemi

    Interesting! For a low resource setting like ours in Africa, this indeed is a big reminder to avail ourselves of the “available” rather than crave for the “desirables” that have remained inaccessible due to funds.
    The unavailability of high tech cardiovascular procedures in our community make regular aspirin use even more attractive, with the hope that lesser patients would need them afterall…because for us really, it’s about primary prevention.

  31. Imoekemhe, Saliu

    Why are doctors not aware of this medicinal properties of asprin?
    Imoekemhe

  32. Rosy

    nope. not me. I’m afraid of taking any meds, including aspirin. I’ve read conflicting accounts about women taking even baby aspirin for TIA .

    With TIA, stroke and heart attacks, your goal is to thin the blood, right? That’s why doctor’s prescribe baby aspirin. Thing is, once you start on baby asprin, you can’t get off without getting yourself into trouble. There are spices such as turmeric, ginger, cayenne peppers cherry, and cinnamon that people can use every day without risking side effects.

    Also, when you take aspirin,, it can cause trouble if you eat other foods that also are blood thinning.

  33. William

    Several years ago I had two TIAs that each took me to the ER. Each time, they gave me one (1) 350mg aspirin and the symptoms were relieved. All the rest was details, complicated and expensive to no further benefit.

    Now, on advice of my GP and neurologist, and instead of Plavix, I take an 81mg every day, and another at night. No further TIAs. I now also have an emergency aspirin holder on each of my key chains.

    Not a religious person, but if I were looking for proof of divine intervention it would be aspirin.

  34. J.A.HALL

    I have Barrett’s Esophagus and chronic gastritis. Would not aspirin be more harmful than helpful? 83 years old but have had no strokes or heart attack.

    Arn

  35. Carole Sheavex

    I was taking Plavix ( expensive). to prevent more T.I.A.’s but bleeding too much so Hematologist suggested one baby aspirin, 81 mg. every evening & said ” “it is just as effective & cost a lot less!” I am sold on daily low- dose aspirin! Not kept in refrigerator either…

  36. Wu

    According to https://www.ncbi.nlm.nih.gov/pubmed/1922220, “CONCLUSIONS: Our data indicate that 30 mg of aspirin daily is no less effective in the prevention of vascular events than a 283-mg dose in patients with a transient ischemic attack or minor stroke, and has fewer adverse effects.”

    There is no 30mg Aspirin in the U.S., and 283mg causes bleeding on me. So, I had to create my own solution: dissolve a 325mg Alka-Seltzer in 11 oz water, then take 1 oz of that compound each day.

  37. The_Ally_of_Orderly_Procedure

    Can one take daily low dose aspirin while taking fish oil supplements? It is my understanding that they both thin the blood.

  38. Tommy

    Weird that a vast number of people take at considerable expense vitamins and patent medicines that have not been shown to provide any significant benefit while they balk at taking low dose aspirin. Maybe some entrepreneur will add low dose aspirin to a “heart healthy” pill package that includes a pointless dose of vitamins, and thereby provide some actual health benefit.

  39. John Pakutka

    What about for those under 50? I’m 52, and have been taking a low-dose aspirin for years.

  40. Robert Bramel

    I’m highly confused about the significance of this. This study uses simulation models, not typical designed experiments, and the simulations make many, many assumptions that are difficult to follow, let alone critique. And the result? It takes 20 years, twenty years!, to effect a one percent reduction in “heart disease”. Weather forecasting uses complex modeling, and would anyone be comfortable depending on that modeling being accurate to one percent? What about mortality from heart disease, and what are the error bars associated with this claim? What about overall mortality, not just from heart disease? And what about effects of stratification? Which sub-groups benefitted and which did not? Even at age 70, the idea of taking something every day for twenty years just to see “a few months” statistically added to my lifetime, is not appealing.
    Read the study. See if you can understand what was done.

  41. Sharon

    Taking 81mg.

  42. jackson

    It’s true that aspirin has among the drug but there is other medicine has drug so people must be carefully.

  43. Maarten Persenaire

    All true and all known for a long time. There is a fascinating book about the history of aspirin, originally published by the Harvard Business Press. More exciting than a Ludlum, and infinitely more informative.
    The Aspirin Wars: Money, Medicine, and 100 Years of Rampant Com- petition, by Charles C. Mann and Mark Plummer. Published by Alfred A. Knopf, Inc. (201 E. 50th St., New York, N.Y. 10022) (1991). 420 pages.

  44. Andrew M. Clearfield, Ph.D.

    It would be helpful if so many internists did not get apoplectic whenever their patients ask about aspirin. Acetaminophen has been grossly oversold to the medical profession as a safer alternative to aspirin in virtually all cases (heart disease aside). It may be safer for the young, and for certain patients with bleeding ulcers and other hemorrhagic disorders, but for most mature patients, it does not confer all the benefits, and has its own risks (to the liver) which aspirin does not. In my personal experience, aspirin is more effective as an anti-pyrolitic, works better with most headaches, and, while not as effective as the NSAIDs, is more helpful with most joint aches and pains than acetaminophen.

    • Bernadette J. Krol

      Very Much Appreciate the comments of Andrew M. Clearfield, PhD!

    • Nancy von Helms

      I use aspirin as a blood thinner because I did not want to continue on Warfarin. I had to change my cardiologist and the current one thinks I need Plavex or Xralto. Why? He never gives me a definitive reason..
      He just can’t seem to accept the fact that low cost, old fashioned aspirin could be just as helpful as the fancy, expensive prescriptions

      • Jacque

        That was my question. Why is aspirin not prescribed for possible DVT or blood clots in general for high risk patients who have been weaned off warfarin or xalerto? And yet it’s a blood thinner too? I ve always wondered if its function in hypertension patients at risk of stroke is different from patients with high risk of blood clots? Also my Dr doesn’t give me a proper explanation. Instead recommends clexane for prophylaxis whenever needed.

    • Arlene

      I agree. Doctors push acetominopfen, and always emphasize the stomach problems of aspirin. But it seems taking an aspirin or two a day as I do should not be a problem. The upper limit of 12 pills over 24 hours could cause a problem but I never have seen a comparison of the amount of aspirin you take vs. stomach problems. I also experience must more relief with aspirin than acetominophen and feel is is safer than ibuprofen.

  45. Paul Snare

    My Virginia Mason, Seattle, internist says full aspirin, 325, not lo-dose.

  46. Walter Mccarthy

    My Irish grandmother said to me, over my taking a baby aspirin, “I want you to take one of these every day.” That was 1952. I was beginning my 6th. year. I didn’t follow her advice, with some exception, I might over the span of a decade or two be given to over several months.
    Soon to begin my 71st year I am having to remind myself to chew a baby aspirin every day.

  47. Bo Springer

    Isn’t aspirin bad if you have kidney disease?

  48. Miller

    Another factor limiting aspirin use may be that it is generic and cheap and therefore pharmaceutical companies have little incentive to promote its benefits.

  49. Linda Aquilina

    Thanks for a great article, it reminded my husband to get back to taking it every day!

  50. Bobo

    To my friends and strangers –I always recommend on box of aspirin to be kept in fridge and when travelling on holidays– Bayer Aspirin A Life saver.