Answering Your Questions About Aspirin, Heart Attack and Colon Cancer

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Answering Your Questions About Aspirin, Heart Attack and Colon Cancer

Earlier this week, an influential medical panel issued new draft recommendations about taking aspirin to prevent heart disease and colon cancer. It was the first time a major medical organization has recommended using low-dose aspirin to ward off a type of cancer, but the guidelines from the United States Preventive Services Task Force aren’t for everyone. Here are answers to some of the questions people are asking.

Who should start taking aspirin based on the new guidelines?

The guidelines are still a draft recommendation, but if they are approved they will be aimed at a specific group of adults who meet the following criteria:

· 50 to 69 years old

· No prior history of heart attack but at high risk for one

· No risk factors for internal bleeding

· Expect to live for at least 10 years

The potential benefit of aspirin therapy is greatest for those aged 50 to 59. As people age, the risks of taking aspirin increase “and people in their 60s may not live long enough to derive the colon cancer benefit,” which takes five to 10 years to accrue, said Dr. Kirsten Bibbins-Domingo, a professor of medicine at the University of California, San Francisco, and vice chair of the United States Preventive Services Task Force, which issued the recommendation.

So how do you know if you’re at high risk for a heart attack and a candidate for aspirin therapy?

The guidelines define “high risk” as someone who has a 10 percent risk of suffering a heart attack over the next 10 years. You should talk to your doctor before you start taking aspirin, but you can calculate your risk by using an online risk calculator like this 10-year risk calculator from the National Institutes of Health. You will need to know your cholesterol and blood pressure.

In addition to high blood pressure and cholesterol, risk factors for heart disease also include smoking, being sedentary, having diabetes, being overweight, having a family history of heart disease and being older. Men are generally at higher risk than women, and risk is higher among certain ethnic minorities including African-Americans, Mexican-Americans, Native Americans, Hawaiians and Asian-Americans.

Are people at high risk for heart disease also at increased risk for colorectal cancer?

Certain behaviors and risk factors that contribute to heart disease also increase the chances of colorectal cancer, including smoking, obesity, Type 2 diabetes, advanced age and being sedentary.

So why not put everyone on aspirin? I don’t have any risk factors, but I want to prevent heart disease and cancer, too.

Aspirin is a powerful drug – just because it is sold without a prescription doesn’t mean it’s not potentially dangerous. Serious, potentially life-threatening side effects include gastrointestinal bleeds and a type of stroke called a hemorrhagic stroke, or brain bleed. You don’t want to expose yourself to serious risks like these unless there’s a clear benefit, like preventing a potential heart attack. Keep in mind you need to take low-dose aspirin for five to 10 years to reap the colon cancer protection benefit and in the short term, you are at risk of bleeding complications.

Keeping your weight down, managing your blood pressure and cholesterol, being physically active, eating a healthy diet, not smoking and getting a screening colonoscopy at age 50 will go a long way toward preventing both heart disease and colon cancer.

What about people who were using aspirin under the existing guidelines? Should they continue to take it?

If you are taking aspirin on your physician’s advice, you should continue to take it. Earlier guidelines issued by the U.S.P.S.T.F. in 2009 recommended aspirin for men aged 45 to 79 and women aged 55 to 79 when the potential benefits of fewer heart attacks for men and fewer ischemic strokes for women outweighed the risks of gastrointestinal bleeds. If you are already in your 70s or 80s and have never had a heart attack, ask your doctor whether continuing to take aspirin is a good idea.

Is there anyone who should definitely not take daily aspirin? How do I know if I’m at risk for bleeding?

If you have ever had a gastrointestinal bleed or ulcer, you are at a heightened risk for another bleed and probably should not take aspirin. Other risk factors for internal bleeding are a history of upper gastrointestinal pain, a bleeding disorder, renal failure, severe liver disease and thrombocytopenia (a platelet deficiency).

Use of anticoagulation drugs (known as blood thinners) and additional nonsteroidal anti-inflammatory drugs (like ibuprofen and naproxen) can increase the risk of bleeds, as may omega-3 supplements. Tell your doctor about all drugs and supplements that you take. Smoking, diabetes, high blood pressure and large amounts of alcohol are also associated with brain bleeds. Men have twice the risk of serious gastrointestinal bleeding than women.

“You should have a conversation with your physician. This is not a ‘do it yourself,’ recommendation,” said Dr. Mark Creager of the American Heart Association

How much daily aspirin do the guidelines recommend?

The guidelines recommend a low-dose aspirin of 75 milligrams per day, but allow for people to to take the most commonly-available dose, which is an 81 milligram baby aspirin. There is no benefit to a higher dose but there is a much higher risk of bleeding complications if you take a higher dose than recommended.

How does aspirin reduce colon cancer risk?

Scientists aren’t entirely sure, but aspirin is an anti-inflammatory agent and inflammation can contribute to causing cancer, said Eric Jacobs of the American Cancer Society.

“Aspirin may lower risk of colorectal cancer the same way it lowers risk of heart attacks, by shutting down some of the activities of platelet cells in the blood,” said Dr. Jacobs. “Platelets, unlike most other cells, are very sensitive to low doses of aspirin, and there is evidence that active platelets can contribute to the development or growth of cancer.”

Aspirin is known to inhibit an enzyme called cyclooxygenase-2 or COX-2. Many colorectal cancer tumors are positive for COX-2, an enzyme that is not expressed in a healthy colon but which flares up under some circumstances and may be involved in fueling abnormal cell growth, experts say.

What do we know about aspirin’s effects on other types of cancer?

Not enough. The U.S.P.S.T.F. evidence reviews did not find evidence that aspirin significantly reduced overall cancer deaths, but other analyses have found significant reductions. Dr. Jacobs said there is “strong evidence” aspirin use lowers the risk of esophageal cancer and “fairly good evidence” it lowers the risk of stomach cancer. There is even some evidence aspirin might slightly lower the risk of more common cancers like breast cancer, prostate cancer and lung cancer, Dr. Jacobs said, and a recent study suggested it lowers ovarian cancer. Even so the evidence is far from definitive.

Related via the link below...

In a First, Aspirin Is Recommended to Fight a Form of Cancer

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Aspirin Risks Outweigh Benefits for Younger Women

http://well.blogs.nytimes.com/2015/09/16/answering-your-questions-about-aspirin-heart-attack-and-colon-cancer/