Aspirin: The Health Solution With Legs

It seems that every week a new drug makes headlines—often because it’s being investigated or outright pulled from the market because of complications that somehow the U.S. Food and Drug Administration missed during its approval process. So when you hear about a medication that has been on the market—virtually without scandal—for more than a century, well, that seems like a pill worth taking a look at.

It’s trusty, ubiquitous aspirin.

A study released in August estimates that as many as 45,000 lives could be saved each year if 90 percent of American adults took aspirin daily to combat stroke and heart disease. Now, fewer than half of adults take aspirin preventatively, according to the study (which was funded by the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and the WellPoint Foundation).

Another benefit: Aspirin costs mere pennies a dose. “It’s certainly cost-effective,” says Dr. Nieca Goldberg, medical director of New York University’s Women’s Heart Program. “And it’s certainly been proven for years—which is more than we can say about a lot of other medicines out there.”

The discovery of aspirin is credited to a German chemist who, in the early 1800s, formulated a compound of salicylic acid derived from willow bark. It reportedly helped relieve the pain of arthritis sufferers, but it also wreaked havoc on their stomachs. But in 1897, a gentler, synthetic form of salicylic acid was formulated by chemists at Bayer in Germany. “Most people don’t realize that aspirin was really the start of the modern pharmaceutical industry,” says Dr. Steven Weisman, head of global health care practice at Innovative Science Solutions in Morristown, N.J. Before aspirin, pharmacists would each compound their own medicines. “Aspirin was the first medicine to be tableted and sold in a uniform way,” he says.

For several decades after its introduction, aspirin was the drug of choice for soothing pain and inflammation. It works by blocking COX-1 and COX-2, two types of enzymes in the body that control important functions—COX-1 helps maintain the lining of the stomach and COX-2 causes inflammation. The fact that both are disabled by aspirin means that while the drug relieves pain and inflammation, it can also cause some stomach irritation (especially at higher doses).

But it wasn’t until the 1970s that another discovery was made that changed the way aspirin was taken and perceived. Turns out that some of the prostaglandins that are blocked by aspirin are responsible for blood platelet clotting. Of course, we need to be able to form clots (to keep from bleeding to death from even a small cut), but we also need to break up or prevent the type of clots that sometimes form in arteries (the cause of heart attacks and strokes).

“Other analgesic drugs [such as ibuprofen and acetaminophen] don’t have the same anti-inflammatory effects that aspirin has,” explains Dr. Thomas Bryant, president of the Aspirin Foundation of America. Those newer drugs are the result of people trying to develop an aspirin without the side effects—something that prevents clots but doesn’t irritate the stomach. “But the very thing that causes the problems is what cures the disease,” says Bryant.

The first concrete evidence of aspirin’s power to prevent clotting—and therefore heart attacks—came out of the Physician’s Health Study, published in 1989. Looking at more than 22,000 men aged 40 to 84, the study found that those who regularly took aspirin had a 44 percent reduction in first heart attacks over the non-aspirin group. That remarkable decrease spurred doctors to start recommending daily aspirin therapy for most men over age 45. But it wasn’t until 2005 that similarly compelling evidence in favor of aspirin emerged for women. The results of the Women’s Health Study (which followed 40,000 women ages 45 to 80) showed that the women who took 100 milligrams of aspirin every other day had a 17 percent reduction in strokes—but, unlike men, aspirin did not seem to reduce the risk of a first heart attack.

“There’s no reason to believe that aspirin works differently in men and women,” Weisman says. “More likely, the differences we see are the result of the protective effects of estrogen in women.” In premenopausal women, estrogen levels are thought to protect them from heart disease, but by the time women are in their 60s, their risk is generally equal to men (and presumably, the benefits of aspirin use would be the same as well).

“That’s why the current recommendations call for a low dose (81 milligrams) aspirin every day for men over age 45 but not for women until age 65,” says Goldberg. “In younger women—provided they are healthy and have no history of high cholesterol or high blood pressure—aspirin has not been shown to reduce risk of heart attack.”