Brain bleeding is very rare. That 38% number is a *relative risk ratio*. I'm always wary of studies that use such ratios to make an effect seem large. The following excerpts from the article you cited state:
For the study, the researchers analyzed data from 19,114 adults with an average age of 74 years old.
Altogether, 1.1% of those taking aspirin (108 individuals) experienced intracranial bleeding, while the same was true for 0.8% of those taking a placebo (79 individuals).
It always amazes me how you can take numbers and twist them they way they fit you and be technically correct. I bet many (if not most) people will only remember the headline.
This is a meta-study, touching on that "contrast" already: there is a subsection in the paper dedicated to this, where they claim that
"The major factor in cerebral bleeding however is hypertension, and in an RCT of aspirin based on more than 18,000 hypertensive patients—all of whom were receiving ‘optimal’ antihypertensive treatment—there were no additional cerebral bleeds in patients randomised to aspirin" (Refs 46 and 47).
which seems to be in contradiction with the article corresponding to the news you linked to: https://jamanetwork.com/journals/jamanetworkopen/fullarticle... and strangely doesn't cite or comment on Refs 46 and 47 from the paper of the main thread, possibly because they don't seem to be focusing on older adults.
There is also a subsection on gastrointestinal bleeding.
Intracranial bleeding isn't necessary something that cause permanent damage, or lethal by the way.
Aspirin is also associated with gout. I'm not sure if the dosage required to worsen gout is lower than the dose discussed in the paper. I merely caution that anyone thinking about increasing their aspirin usage to prevent cancer should consult a GP first, since it's complicated, and anyone who has had gout probably doesn't want to increase their rate of flare ups.
Well the worseness has to be counteracted by how likely it is. A 38% increase in something quite rare (brain bleeds) is nowhere near as impactful as a 20% reduction in cancer, which is much more common.
This is a meta analysis of observational studies.
There's random controlled trial which showed all cause mortality was 14% higher for "healthy older adults who received daily aspirin than among those who received placebo"
The meta analysis is studying asprin as a cancer treatment, so the subjects were patients who already had cancer, not healthy adults taking it as a preventative. Daily asprin could both be bad for healthy adults and good for cancer patients.
I wonder if this is a reduction in mortality that was caused by an increase in chronic inflammation from modern life, stress and obesity.
In a healthy fit human, inflammation is a good thing, it is the body's construction and maintenance crew. Chronic inflammation is not good, but that is a side effect of an underlying issue (in my understanding so far)
People who are diligent to keep taking an aspirin pill day in and day out even though they are not sick are likely sufficiently worried about their health to also subject themselves to timely cancer screening.
Disclaimer: A lot of his stuff is pretty out there, and some of it may be outright wrong. I don’t recommend following his advice, but a lot of his writing is at least interesting.
Increases risk for hemorrhagic strokes as well. AFAIUI, your clotting ability is impaired, so if you get a minor bleed, it's not minor for long.
IIRC, the recommendations to folks taking aspirin for heart attack prevention is "don't, unless you've already had an ischemic event" because the risk outweighs the benefits for everyone else. That could change if we find new and/or unexpected benefits from low-dose aspirin.
yes, hemorrhagic strokes are less frequent, but much worse. I don't think it's quite a wash in the end, but closer to one if all we care about is outcomes (and that's all I do!)
I am very skeptical about these side effect claims. Do you have hard data supporting this or doctor hearsay. Years ago I remember watching Charlie Rose Brain series where one of the professors said something like “ we know of two drugs that we are certain are very safe for human beings: alcohol and aspirin.”
Anecdata: even a few days of low-dose aspirin causes me terrible GI pain and exacerbates an otherwise 30-year dormant ulcer. I would love to be able to take it, but I can't tolerate it at all.
meh, I just care about all-cause mortality. I'll accept some preventable death risk if it's outweighed by non-preventable death risk improvement.
I think the French hit a good sweet spot between high alcohol consumption and high life expectancy. Quite a male-female disparity though. Maybe Irish do better at 0.2years reduction for an extra 0.4l of alcohol per year
Also addressed in TFA, it turns out. GI symptoms are pretty mild in the universe of cancer drug side effects, and the aspirin slows metastatic cancer spread considerably, so seems like a no brainer.
It isn't a cancer drug, so that isn't a fair comparison. GI symptoms from eating more broccoli and not ever drinking are also pretty mild compared to cancer drugs. Aspirin appears to be a preventative according to some initial research. National cancer institute says even the most at-risk age group (age 60+) is still only has cancer rates of around 1 in 100. How long are you going to take low dose aspirin?
Are GI symptoms mild if you take low dose aspirin on a daily basis for 30 years? 40? Longer even? All to reduce your odds of getting cancer from 1 in 100 to 1 in 120 at the latest stage of your life. The gains are marginal in younger stages of your life where cancer rates are much lower.
Don't get me wrong, if this is validated it's a very interesting result. A mechanism of action could be potentially groundbreaking. It doesn't mean start taking aspirin every day for the rest of your life at age 38 just to be on the safe side, however.
It is also worth considering that this is purely an association at this point. It is possible that some of this effect is because cardiovascular disease, the primary reason for taking low dose aspirin, tends to kill people before the odds of getting cancer have time to really flex their muscles. We might assume that ethical researchers without perverse incentives working within a system primarily concerned with scientific truth would have ruled out that possibility... but then we would be idealists who are ignorant of how the world works. Or any other number of reasons why this might turn out to be a big old pot of nothing to get excited about.
Long term low-dose aspirin regimes are well studied and common (for cardiovascular protection). This isn't some oddball thing the study is suggesting people do; the reason they were able to survey over 1MM pts is that so many people are already doing this.
Meanwhile --- and I say this as a stalwart enjoyer and advocate of crucifers of all kinds --- broccoli is simply not associated with dramatic suppression of cancer metastases.
The study population was cancer patients, so low dose aspirin was studied as a cancer drug. It doesn't say what the effect would be in the general population. Don't take aspirin just because it might help cancer patients, but if you've had cancer, consult with your oncologist.
> It doesn't mean start taking aspirin every day for the rest of your life at age 38 just to be on the safe side, however.
Younger people than that do get cancer and die from it. If it arrests tumour growth and even sometimes causes reduction and one is at risk, resisting aspirin treatment out of cargo cult common sense is a bad idea.
Only for some people, I've taken low dose aspirin (family history of heart attack) for 20 years now without any side effects (except perhaps not dying from heart attacks)
I'm annoyed that the FDA has kept cox-2 selective inhibitors restricted when the data I've seen shows they have lower GI risks and similar cardiovascular risks as other NSAIDs.
because the FDA are sticks-in-the-mud who get blowback when they approve something bad and but barely hear anything if they delay or restrict something good. there was also a to-do about celecoxib potentially increasing risk of heart attacks, plus the off-label marketing thing that led to the largest (at the time) settlement of that sort in history.
the process was also crazy complicated until some new 2020 legislation. the FDA published monographs saying things like "you can make a pain reliever with the following active ingredients and in the following forms." for example, no changes to the monographs on cough and cold medicines were made between 1987 and 2020. the new regime is of course a new mess to figure out, and consumers won't necessarily know the difference between a selective versus nonselective cox inhibitor. so you spend all this money and maybe inertia just keeps people buying ibuprofen and naproxen because it's what they know. and marketing something explicitly as "safer than ibuprofen" would be a massive hurdle to get cleared.
you can find all the FDA's monographs here, where it lists specific ingredients, concentrations, labeling, and testing procedures. https://dps.fda.gov/omuf/monographsearch
Oh i remember reading all of these studies 10 years ago and thinking they had so much potential relative to the small but significant risk in MI. I hope they are reevaluated at some point.
Common misconception, it's actually best to take with alcoholic beverages containing dairy. So like a white Russian.
(I'm obviously joking, this is your friendly reminder not to take medical advice from randos on the internet, especially when their source is "I've heard").
I did hear something from a stranger about hearing somethings on internet from strangers so this tracks, it would seem. I will comply fully henceforth!
/e: on a more serious note, what @codevark was downvoted to oblivion for: I'd be interested in a comparison of the anti-inflammatory aspect of aspirin vs food/diet. Anyone got an idea?
Aspirin is anti-inflammatory. A huge number of illnesses are caused or worsened by inflammation. Aspirin is likely to show benefit for a huge variety of conditions.
It's a complicated topic, biochemically / physiologically, however. Guidelines and recommendations have changed many times in the past couple of decades. With the scale of epidemiological data collection and specific studies carried out in recent years, conclusions are still rather "mixed".
There are many reasons to think, mechanistically, that aspirin (acetylsalicylic acid) should come out "net positive" in its effects on human health. But, even some of the "prostaglandins", for example, can be important in endothelial function and health (in a positive way).
I will note that I haven't kept up with this topic much in at least 5 or so years, but, I can point to a couple of sources with some analysis / discussion that should be of use to most, I think:
I specifically remember concerns roughly 10+ years ago that some of the expected net benefits might, in fact, actually be net harms in the broader population - particularly for other NSAIDs (non-steroidal anti-inflammatory drugs), but, even, at some point not long thereafter, for "aspirin" as well. I may dig out that info if I get a chance to try to refresh, myself, and will comment again if / when I do.
I always think of Lewis Black's bit on this, though (while pointing out that this is the nature of science and its best to go with the best info available at any time, generally, IMO):
this is my napkin math read as well, but aspirin is an inhibitor of both COX-1 and 2 with somewhat higher affinity for the former. this leaves you messing with something else that's important for regulating platelets, your gut, etc. even selective inhibitors of the latter aren't out of the woods yet. there's some literature that's starting to suggest COX-2 may be at least somewhat constitutive in some tissues (endothelium, hence coronary vasospasm) even if it's also mostly inducible.
not sure why no one has tried developing a prostaglandin e2 inhibitor instead. going further downstream might be safer.
> Currently, a number of randomised trials which test aspirin and mortality are in progress. These focus upon the common cancers: colon, breast, prostate and one in lung cancer. One of these trials, based upon 3021 selected patients in remission from a HER2-negative breast cancer, has already reported [31]. This trial was ended prematurely because aspirin was associated with a possible increase of about 25% in deaths.
Classic baby/bathwater disposal problem. There are plenty of medicines that are beneficial for some applications but harmful for others. Maybe all of them, to some extent? That's why the authors wrote dozens of other sentences in that article.
