Aspirin May Increase Risk of Stomach Problems
MADELEINE BRAND, Host:
Here to answer that question is Dr. Sydney Spiesel of the Yale Medical School. He writes about medicine for the online magazine Slate, and he joins us now from his office in Woodbridge, Connecticut. Hi, Syd.
SYDNEY SPIESEL: Hi, Madeleine.
BRAND: First, Syd, remind us again why most doctors recommend that people who are at risk of heart attacks or strokes should take a daily aspirin.
SPIESEL: Aspirin suppresses the production in the body of a material called prostaglandin, which leads to - if you take aspirin, your blood clots a little bit less easily, so it's a little bit less likely to clot, and it's also - aspirin, as we all know, is an anti-inflammatory. And both of those things seem to help to prevent both heart attacks and strokes. Actually, it prevents heart attacks more in men and strokes more in women, but it prevents both of those things.
BRAND: And what about this new research that shows that it may have some problems with the digestive tract?
SPIESEL: We've always known that people who take aspirin are at risk for excess gastro-intestinal bleeding or ulcers that perforate and - but nobody knew exactly what - how much additional risk the aspirin provided. Does the risk balance the benefit? And that was the question that was answered in this study.
BRAND: And what's the answer?
SPIESEL: The answer, as always, is more complex than you think. There's no simple answer. The three factors that particularly affect developing gastro-intestinal complications are increased risk, male gender and ulcer history. And all of those things are about doubled when you take a daily low dose aspirin. And that was based on looking at three million patients in the United Kingdom and a million patients that were studied in Spain in large databases. The study was done by Sonia Hernandez-Diaz of the Harvard School of Public Health and Louis Rodriguez of a center for epidemiologic study in Spain.
BRAND: Given the fact that heart disease and stroke can be fatal, and if not fatal then extremely debilitating, is it worth the risk? Because it would seem that maybe having a problem with your gastrointestinal tract would be the lesser of the two evils.
SPIESEL: These aren't just a little irritation on the stomach. These are serious complications.
BRAND: That can lead to death?
SPIESEL: That can lead to death. About five to ten percent of people with these complications will die from it.
BRAND: Syd, what is it exactly in aspirin that causes these problems?
SPIESEL: Well, the thing that is in aspirin that causes these problems is in a way the same thing that prevents the heart disease, and the same prostaglandin changes are the ones that somehow enhance the probability of developing gastrointestinal irritation that can lead to bleeding, that can lead to perforation.
BRAND: So balancing the risks of the two, what would you recommend?
SPIESEL: Well, I recommend what I recommend for everybody, which looking at the patient. If you have - remember the risks: male, elderly, peptic ulcer disease. So you have an elderly male patient with the history of ulcer disease, there the risks might not be worth it in terms of protecting from heart disease. On the other hand, if you have a younger patient who is possibly female, there the risk would be low and wouldn't matter very much.
BRAND: That's opinion from Dr. Sydney Spiesel of Slate.com. And Dr. Spiesel is a practicing pediatrician. Thanks for joining us, Syd.
SPIESEL: Always a pressure to be here.
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