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BLOG: March 2007

To aspirin or not?

Can a daily aspirin dose significantly influence your health? A 24-year long Nurses' Health Study by the researchers from Massachusetts General Hospital and Harvard Medical School, Boston, rounded up statistical results for long-term aspirin effects. They show that low-to-moderate aspirin users within the group under study had cancer caused deaths lower by 12% and cardiovascular by 38%, with a total of 25% lower death rate from any cause (CNN, BBC).

The study followed nearly 80,000 women, 35 to 60 years of age at the start in 1980, checking on their aspirin use every 2 years, up to the year 2004 (average age went from 46 at the beginning to 70 at study's end). Within this group, over 40,000 did not use aspirin on regular basis, nearly 30,000 used low-to-moderate dose of 1 to 14 325mg tablets per week, and 5,000 used more than 14 tablets per week.

There was no significant statistical difference in death rates between non-users and high-dose aspirin users.

The problem with this study is that it contradicts earlier well established studies that found no such benefits from taking aspirin. One of them, the British Woman's Health Study, followed 40,000 woman for 11 years. And several studies found that aspirin actually doubles the risk of stroke.

To make matters more confusing, the fact is that aspirin should - just as any other blood thinning agent - lower, at least to some measurable extent, the risk of heart attack. The reason is a silent,

widely ignored mass killer called "deep vein thrombosis" (DVT).

Blood clots that usually form in large (deep) veins of the legs travel to the upper body and get stuck in the vessels of lungs (causing pulmonary embolism), heart (heart attack) or brain (stroke).

The risk factors for DVT are many, and they can outweigh positive effect of blood thinner in any individual. However, positive effect should show in large group's average. The fact that studies differ so much in their results is, in good part, due to the difficulty of identifying and tracing all factors that can influence the outcome (this goes for health-related studies in general).

Another problem of this study is that some major numbers do not fit into well established general trends. While the leading cause of death among women in the general population is cardiovascular disease, in the study it is cancer, by a factor of 2.5 over cardiovascular diseases(4,469 deaths from cancer vs. just under 2,000 from cardiovascular disease). Even when adjusted for lower death rates in low-to-moderate aspirin users group, cancer deaths still outnumber those from cardiovascular disease by about a factor of 2.

Such a major discrepancy alone makes credibility of the study questionable.

Of course, any indirect study, depending on reports by participants themselves, is less reliable than clinical studies controlling at least major factors, such as the actual doses of the agents tested. In addition, the fact that it didn't take into account other important factors, such as diet, forms of dietary supplementation, lifestyle and other medications used makes study's result inconclusive by its very concept.

The question is, why was such an inherently flawed concept chosen in the first place?

Poorly controlled studies are probably the main reason for confusing, often contradictory results. A 1993 study published in the New England Journal of Medicine had the risk of cardiovascular disease in a sample of over 87,000 nurses

cut by 41% with a daily dose of 100 I.U. of vitamin E alone.

Some recent studies (GISSI Prevenzione Trial), on the other hand, had found no benefit from it whatsoever. Part of the reason is that it does matter which form of vitamin E one uses (synthetic is less potent, and can have negative side-effects), in what dose, and also, for the natural form, whether it includes only alpha-tocopherol, or all eight of its natural components.

Also, vitamin E is significantly more effective when combined with vitamin C, and both are significantly more effective when sufficient level of other antioxidants like lipoic acid and coenzyme Q10 - which also restore used up vitamin C and E to their antioxidant potential - are present. It is all important -

no single nutrient can compensate for
deficiency of other key nutrients.

To the contrary, vitamin E effectiveness can be significantly reduced by antagonists like inorganic iron, synthetic estrogen and estrogen mimics, chlorine, or high dietary intake of polyunsaturated oils.

This illustrates only a part of the complexity involved in such studies. It is safe to say that no study so far has come close to controlling all relevant factors, and many - including the one in the question - don't even attempt to.

Assuming that the result of the study are correct, what would be its importance? Even at the optimum dose, which is according to the study's results about one 325mg tablet a day, the risk of ulceration and bleeding caused by aspirin becomes significant.

On the other hand, the anti-clotting effect, which is considered to be the main beneficial factor from the use of aspirin, can be achieved safely with daily supplementation of vitamins C and E, Omega-3 fatty acids, amino acid arginine, or enzymes, in particular bromelain.

Arginine has additional vasodilating benefit, from stimulating nitric oxide production.

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