Can aspirin prevent both heart disease and cancer?

Tracy Rupp, PharmD, MPH, RD, and Laura Gottschalk, PhD

Updated 2017

 

Doctors have prescribed aspirin to prevent heart attacks and stroke for many years but now a panel of experts says it can also help prevent colon cancer, too. “The people we recommend taking aspirin are at an increased risk of cardiovascular disease and who are not at an increased risk of bleeding complications,” said Dr. Doug Owens, a member of the panel.

The recommendation

The recommendations in September 2016 from the U.S. Preventative Service Task Force (USPSTF), an independent group of medical experts, state that people between the ages of 50 and 59 years who are at an increased risk of heart disease and stroke should take 81 mg of aspirin daily (which is typical dosage of “baby” or low-dose aspirin). There are exceptions however, such as anyone with an increased risk of bleeding because of other medication they are taking.  In addition to preventing heart attacks and strokes, low-dose daily aspirin can also reduce the chances of developing colon cancer if it’s taken for at least 10 years.

Consistent with these recommendations, a study published in 2016 looked at the rate of cancer in about 136,000 men and women; some were taking aspirin while others were not. They found that people who took standard or low-dose aspirin at least twice a week were 19% less likely to develop colorectal cancer compared to people who didn’t take aspirin. Additionally, this study noted that the protective effects of aspirin were seen after just five years of use ¹.

This recommendation is not for everyone between 50 and 59, however. For example, if you have an increased risk of bleeding because of other medication you are taking or because of a history of stomach or intestinal ulcers, kidney disease, or severe liver disease, the risks of taking aspirin daily may outweigh the benefits. “Taking aspirin is easy, but deciding whether or not to take aspirin for prevention is complex,” said Kirsten Bibbins-Domingo, vice chair of the task force and a professor of medicine at the University of California, San Francisco. The new recommendation is specifically for people expected to live at least 10 years, and who are at a 10 percent or greater risk of heart attack or stroke during that time. You can figure out what your risk is by using this calculator, which takes into account various risk factors for heart disease and stroke, including age, smoking status, cholesterol, and blood pressure.

Do I need aspirin?

For people ages 60 to 69 years, the guidelines say the benefit is not as large compared to people ages 50 to 59 years, so the decision to take aspirin should be made on a case by case basis. While older people are at a greater risk for heart disease and stroke, they are also at an increased risk for life-threatening bleeding. The experts said they did not have enough data to determine whether people aged 50 or younger and people aged 70 or older should also take aspirin.

Lifestyle is still important for cancer prevention

Dr. Ranit Mishori, a professor of family medicine at Georgetown University, called the task force’s new recommendation “very intriguing and even exciting,” particularly regarding prevention of colon cancer.  However, she said it likely won’t change how she approaches the topic with her patients: “While I am excited to offer this as an option to my patients, I will continue to emphasize and insist they adhere to other colorectal cancer prevention strategies such as maintaining a healthy diet — eating a diet rich in fruits and vegetables and low in red meat — exercising, not smoking, and to recommended colorectal screening protocols.”

Am I at risk?

• Heart disease and cancer are the leading causes of death in adults in the United States. In 2011, more than half of all deaths in the United States were caused by heart disease, cancer, or stroke.²,³

• The most important risks for heart disease include: smoking, high cholesterol, high blood pressure, diabetes, older age, and male sex.⁴

• Risk factors for colon cancer include: older age, family history of colon cancer, Crohn’s disease or ulcerative colitis, obesity, smoking, alcohol, poor diet, and lack of exercise.⁵

• The chances of dangerous stomach and intestinal bleeding with low-dose aspirin use are higher for people with the following risk factors: higher doses of aspirin, history of stomach or intestinal ulcers, bleeding disorders, kidney disease, and severe liver disease. Other factors that increase a patient’s chances of bleeding in the stomach, intestines, or brain with low-dose aspirin use include: taking certain medications like warfarin, heparin, and nonsteroidal anti-inflammatory drugs (NSAIDs); high blood pressure; male sex; and older age.⁶