The discovery of aspirin starts thousands of years ago before it was first marketed by the pharmaceutical company Bayer in 1899. It began with natural sources of similar compounds. Ancient civilizations such as the Sumerians, Egyptians, Chinese and Greeks used willow bark and related plants, like meadowsweet, for pain relief, fever reduction, and treating inflammation. I always reflect on the first person who decided to chew on the bark of a willow tree who realized, “hey this stuff helped my headache, or bad knee or the temperature I had from this infected boil on my (insert anatomical part of your choice). Could you imagine today, if your best friend or your spouse said “Hey I had this itch in my ear and it started to ache and I was feeling some melancholy so I decided to chew on some pine needles and you know, I think it got better. You should try it.” I digress, but thanks to all of the experimenters of the past who civilization didn’t label as the crazy ones in the villages back then. The father of medicine, Hippocrates himself (around 400 BCE) is sometimes credited with recommending willow bark for these purposes.
The name Aspirin was coined by the German pharmaceutical company, Bayer as a trade mark for their new drug, acetylsalicylic acid. It is derived from a combination of word parts. The “A” stands for acetyl (the acetyl group added to salicylic acid during the synthesis, which makes it more stable and less irritating to the stomach than plain salicylic acid. “Spir”derives from Spiraea the former scientific name of the plant commonly called meadowsweet, which was a a key natural source of salicylic acid. and “-in” was a common suffix used in drug names in the 19th century (similar to other medications like “heroin”, which Bayer also introduced around the same time).
Since it was marketed in 1899 it was deemed the “turn -of-the-century miracle drug”, for obvious reasons. It could be used for analgesic effects, anti-pyretic effect (fever-reducing) and anti-inflammatory purposes. It also could be used for rheumatic conditions, headaches, colds, muscular aches and could even be gargled to help throat pain.
It wasn’t until the 1970’s before its antiplatelet (blood-thinning effects) were discovered and it became widely used for heart attack/stroke prevention. We physicians would recommend using it to prevent a heart attack or stroke. This was considered primary prevention (Using it to prevent the complications of a disease that you may not have or be at risk of having). We would assess for cardiac risk factors that include Age >50 in males or >55 in females. Hypertension, Diabetes, Hyperlipidemia (elevated cholesterol), Family history of cardiovascular disease, Smoking and Obesity, to name the most common risks. As you can see, most of you will have at least one risk factor if not many more. Age alone is the strongest cardiovascular risk factor. (The older you are the more likely you will be to have a cardiovascular event. (Heart attack or stroke). It was in 2016 when the potential benefits were being questioned for primary prevention because of the potential side effect of bleeding be it gastrointestinal or a cerebral hemorrhage (brain bleed).
What is being lost in the primary prevention group is that even though there may not be significant cardiovascular benefits (there is but it may be smaller than the risk of bleeding) there are additional benefits to aspirin that they are not considering. I find that many specialists put blinders on and do not consider the big picture of one’s health and only focus what they specialize in. A cardiologist will focus just on the heart. A gastroenterologist will only focus on the gastrointestinal tract and so on. It takes time to consider the big picture and determine whether a treatment is right for you.
Aspirin offers several other health benefits beyond heart health, including potential cancer prevention, cognitive function improvement and anti-inflammatory effects.
One of the most significant benefits of aspirin is its potential role in preventing certain types of cancer, particularly colorectal cancer. Taking >75mg of aspirin (typically baby aspirin 81mg) for several years can reduce the long term incidence and mortality from colorectal cancer. Women who used aspirin for over 20 years showed a 35% reduction in the incidence of colorectal cancer. The benefits include many mechanisms but most importantly aspirin has been found to decrease the risk of developing colon polyps and colon cancer starts from an adenomatous polyp. So decreased polyps equals decreased cancer risk. Additionally, aspirin can improve survival rates after being diagnosed with colon cancer as well as other cancers. It has been found that if you have been diagnosed with a cancer, any cancer, the likelihood of metastasis (spread) is less in individuals who were on aspirin at the time of the diagnosis.
Aspirin has been found to have benefits in decreasing the risk of the skin cancers, especially melanoma, which is the most dangerous and deadly form of skin cancer, by activating tumor-suppressant genes. As well as breast cancer reduction by as much as 30%.
Cognitive Function: Aspirin has been linked to improved cognitive function and memory. Research has shown that individuals who are taking aspirin regularly may experience increased memory scores and a reduced risk of developing Alzheimer’s disease by up to 55%. The effect is believed to be due to aspirins ability to break down proteins that cause plaques in the brain, which are associated with memory loss as well as preventing smaller strokes that contribute to microvascular disease and vascular dementia.
There is also the anti-Inflammatory effects which reduce inflammation and the associated pain that comes along with it. I believe the other NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) are more beneficial for pain (Ibuprofen, Naproxen, Meloxicam, Celcoxib, etc…)
Now when it comes to Secondary prevention (This means that you have known heart disease or blood vessel disease or have had a heart attack or stroke). The benefit of daily aspirin therapy is already well established. This is why I like to recommend that anyone over 45 be screened with a coronary calcium score. If there is ANY calcium in the coronaries, it is by definition, coronary artery disease. The main limitation on a coronary calcium score is that we do not know in the calcification is within the artery (The pulp of the tree) of the tree of life of is it on the outside (The bark of the tree of life). Obviously the inside can obstruct flow which is bad and the outside does not. (This will be a separate discussion on determining one’s cardiovascular risks).
The main risks of regular use of aspirin are primarily bleeding risks. This could be major in the form of Intracranial bleeding: (hemorrhagic stroke, subdural or extradural hemorrhage, subarachnoid hemorrhage). Extracranial bleeding: (upper gastrointestinal bleed-esophagus, stomach, duodenum and small intestine, Lower gastrointestinal bleeding-colon, as well as bleeding from other sites. The rate of major hemorrhage was 8.6 events per 1000 person years in the aspirin group, as compared to 6.2 events per 1000 person years in the placebo group (no aspirin group). Which equates to a 0.86 percent chance of a bleed per thousand patient years which equates to a 7.74% in the aspirin group compared to the 5.58% group in the non-aspirin taking group in individuals who live to age 90. Half of the bleeding was from the gastrointestinal tract so this could be decreased by being on an acid blocker (PPI-Proton Pump Inhibitors-Nexium,Prilosec, Prevacidm Dexilant, Protonix, Aciphex…) if one’s risk was high.
The Take Home Message: As we get older we are either going to die from a cardiovascular event (Stroke, Heart Attack), Cancer, Neurodegenerative disorder (Dementia, Parkinsons) or an Accident (trauma, falls-remember, stay off the damn ladders, motor vehicle accidents). Trust me, this is the unfortunate part of my job, when I have to point this out to patients as they age and it begins to affect them. My goal is to try and prevent this from occurring for as long as I can. This is why I am all over you guys (and gals) for not exercising, working on losing weight, not wanting to treat your cholesterol or check your blood pressure and treat it if it is elevated. I don’t like being the one who complains. (The ass in the room). I am trying to be your cheerleader. I am trying to the most out of you. Just like a classic car. (Like my 1975 FJ40 Toyota Land-cruiser because I want it to last forever). Just as I want you to be around , not necessary forever but as long as I can in a healthy fashion. Focusing on your healthspan and not just your lifespan. Let’s be honest, some of us are like cockroaches and live forever despite multiple ailments that do not let us live a rewarding life but let us live in misery and, in my eyes , that is purgatorial.
So the benefits from aspirin are with usage that is generally greater that 5 years when is comes to cancer and dementia prevention and immediate when it comes to cardiovascular prevention. I would recommend that if you are older than forty you should be on a baby aspirin (81mg a day) unless there are absolute contraindications. I never understood, throughout my training why if someone was <50 they it was not recommended they be on an aspirin UNTIL they had a stroke. Let’s get proactive, because as I discussed above, there are more benefits that meet the eye when it comes to the bark of a willow tree. The willow tree symbolizes the moon, grief, healing and everlasting life. As well as flexibility, adaptability and endurance. Lets use the willow to support us in the second half and later parts of our time here. Stay healthy my friends.
Doug
