Tuesday, November 03, 2009

Should I Stop My Daily Aspirin?

I listened with mounting disquiet to a report on 5 Live Breakfast on whether taking an aspirin a day lessens the risk of a heart attack or a stroke. According to a new report it can do more harm than good if you're someone like me with no family history of heart problems. And yet my GP prescribes me an aspirin a day to counter the effects of diabetes.

The new report says that taking an aspirin a day can cause internal bleeding. It echoes the findings of another study by British scientists earlier this year.

The author of this new study, Dr Iheanacho, advises GPs to stop giving aspirin to diabetics.

So, do I listen to my GP or to Dr Iheanacho?


Rebel with Cause said...

did either give actual data re % or number affected per 1,000 ppl using aspirin? If not, watch your reactions but listen to GP.

ContraTory said...

Keep listening to your doctor. It is only when all the evidence points to just one aspirin tablet causing instant death that you need worry!!

Alex said...

'Scientists advise and politicians decide', I think I read that around here somewhere. So up to you, I guess: listen to the expert's advice, or listen to the Health Secretary's decision.

graybo said...

I'd ask your GP what he thinks of the doctor's findings.

Stepney said...

Keep trucking with the Statins and the Rampiril Iain.

I stopped the aspirin about 6 months ago.

(And when is someone going to blow the lid on the scam that surgeries get paid for every "diabetic" they diagnose? And is it the case they dropped the signifying blood sugar level reading to produce more diabetics in the UK? I think we should be told.)

Yours, marginally and marginalised,


Simon Gardner said...

Lisbon Treaty on. Cameron flip-flop widely predicted.


IanVisits said...

It sounds like it is a case of balancing the odds.

It's a question of whether the benefits to the heart outweigh the downsides from internal bleeding.

I'd also want to check who funded the study to check whether the people behind it are keen to push an alternative treatment, and also how many other studies have been carried out that came to different conclusions.

I would probably be more inclined to trust my GP than a doctor on the media as the GP is likely to have a more rounded opinion of the matter than a journalist and a doctor with a press release to promote.

Keen an eye on Ben Goldacre's website as he might dig a bit deeper into how the media are reporting this story.

James Higham said...

Iain, stick to your aspirin after today's announcement by David Cameron that he's abandoning the referendum.

Now we're left searching and scrambling whom to vote for next year. Certainly it can't be for the jellyfish at the top.

Man in a Shed said...

There is of course no right answer, though you should always discuss a change of medication with your GP.

Bardirect said...

Does your GP really prescribe aspirin so that you pay a full prescription charge for this inexpensive over the counter medicine or has he only recommended it (thereby depriving the NHS of that precription charge which in this rare case exceedxs the costs of the medicine)?

GP's are not scientists and in this area follow recommendations made by others.

Dr Iheanacho is now making recommendations derived in part from two recent studies in which thousands of Type 2 diabtetes patients were followed up over long periods.

In http://www.ncbi.nlm.nih.gov/pubmed/19853947?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2 it was concluded that "In patients with diabetes, aspirin therapy did not significantly reduce the risk of cardiovascular events without an increased risk of major bleeding, and showed sex-specific effects on MI and stroke.

In http://www.ncbi.nlm.nih.gov/pubmed/19878541?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1 it was concluded that In Chinese type 2 diabetic patients, low dose aspirin was associated with a paradoxical increase in CVD risk in primary prevention and did not confer benefits in secondary prevention. In addition, the risk of GI bleeding in aspirin users was rather high.

Conclusion: there is no evidence base for prescribing Aspirin when no existing cardiovascular disease.

Now those statins their still under license aren't they so prescribed at great expense....

Vienna Woods said...

Taking an Aspirin a day is not such a bad idea for those with high cholesterol, but it is enough to take 50mg tablets, or even less. The whole idea of an Aspirin a day is that for those of advancing years whose arteries can become silted, the Aspirin has the effect of thinning the blood, allowing it to flow freely. I have suffered from high blood pressure for a number of years and have slightly risen sugar levels. I am not treated for diabetes but take a daily aspirin as well as a very good tablet for the blood pressure (BloPress+).

waymore said...


For God's sake stop taking aspirin; the latest evidence suggests irreparable damage will result via continuation of this harmful drug...but keep on with the statins!

Later that same month: Iain, it is essential that you contnue your daily intake of aspirin as it assuredly heps to avoid stroke BUT leave the statins alone, they are harmful to the middle aged male and adversely affect the libido. Oh, and cats cause cancer.

It is all guesswork dressed in a white coat...stop worrying!

Katey said...

I made the huge mistake of questioning my doctor. When I asked the question, he sat back in his chair, exhaled loudly and said 'who told you this'. 'I saw it in the media'. 'Oh', he said, there then followed a question and answer session at the end of which he said to me, 'I haven't the time for this, either I diagnoise the problem or you DIY via the internet, which is it?'

Needless to say, they're pretty touchy (some of them) about being challenged, so I'd be careful how I put it if I were you, but I'd still do it.

Duyfken said...

Of course, you must be guided by your GP who perhaps has also prescribed Omeprazole to counter gastric damage.

Damon From Birmingham said...


As Iain is diabetic (as am I) he will receive free prescriptions.

As for the aspirin question - I'm mulling the same question myself and I'm still undecided.

Nigel said...

As Bardirect suggests, the statistical evidence indicates that you probably ought to stop the aspirin. Ask your GP about the report.

Eating more whole grains, green vegetables and oily fish would probably do you more good anyway (and there is excellent statistical evidence for that, too.)

JB said...

You should never make a decision about your treatment based on a report about a single scientific paper. Even if you read the original paper, you may misinterpret or overinterpret the data, and there is no knowing what a journalist might have done to it. Medical research is a complicated business and it is wrong to assume that the conclusion of any one paper, even a good one, should be taken as fact.

The only rational thing for a non-specialist to do against this background is to act on the basis of the prevailing scientific consensus. Whether you trust your GP to interpret what the consensus is is another question. Ask him some questions about the research to establish whether he is up to date; if not, find a specialist (and even then, test him to make sure he knows what he is talking about).

JB said...

You should never make a decision about your treatment based on a report about a single scientific paper. Even if you read the original paper, you may misinterpret or overinterpret the data, and there is no knowing what a journalist might have done to it. Medical research is a complicated business and it is wrong to assume that the conclusion of any one paper, even a good one, should be taken as fact.

The only rational thing for a non-specialist to do against this background is to act on the basis of the prevailing scientific consensus. Whether you trust your GP to interpret what the consensus is is another question. Ask him some questions about the research to establish whether he is up to date; if not, find a specialist (and even then, test him to make sure he knows what he is talking about).

Oliver Drew said...

Go to your GP and ask what he thinks about what the findings are Iain - it would be silly just to stop taking them without consulting your doctor, who might well (and given your post, does) have a very good reason to prescribe them too you.

Cardinal Richelieu's mole said...

! Did you disclose this drug habit to the Bracknell burghers?

Could we have been looking at a re-selection, Truss style?

A lucky escape all round really - and at least now you know to stop.

killemallletgodsortemout said...

Forget the aspirin, start on the Warfarin. Gives a much superior blood flow, know what I mean?

jbw said...

Interesting report. My GP has recently asked me to take part in a 5 year trial to see if aspirin is effective in preventing heart attacks. Sadly I was ruled out as being too fit!

DocRichard said...

Iain, it is a question of balancing the risk of heart attack and the risk of gastric bleeding going on to ulceration.

A 300mg tab of aspirin is estimated to make you leak 10ml of blood on average, so the 75mg dose may (or may not, since nothing is proven in science) make you leak half a tsp.

In my practice I saw very little ulceration caused by aspirin-type drugs, and I always strongly advised patients to take them in the middle of a meal, so the pill is less likely to release all its goodness at one point of the gut.

This is just an anecdote. I can find no peer-reviewed, randomised double blind cross-over trial to refute the hypothesis that I (and my colleagues) give good advice on taking with food,
(a) because it is impossible to double blind, and
(puts conspiracy theory hat on)
(b) the manufacturers of proton pump inhibitors (Omeprazone &c) would lose out.

If still undure, just make sure you get 5 portions of fruit and veg a day, (the Australians are on 10), aim for 30 minutes' puffing and sweating exercise a day.

Oh, and don't worry.

That's it, time's up.

Bird said...

I've been taking a 75mg Aspirin for 14 years, fowwowing a heart attack. No problems.
As someone mentioned earlier, Aspirin thins the blood and keeps the arteries open to some degree. As a big, heavy guy, you need to think about heart attacks, never mind diabetes.

Hawkeye said...

Doctors in the 30s advised men to smoke to "soothe" the lungs and throat.

Doctors in the 50s advised people to eat plenty of fat as it helped lubricate the internal membranes.

In the 70s we were told to use saccharin instead of sugar

In the 80s we were told to eat margarine instead of butter

In the 90s we were told to eat butter instead of margarine and aspartame instead of saccharine. Then aspartame went out of favour and sugar was back in - but in smaller quantities please.

Recently we have been told that statins are life savers, then we were told that statins could kill you.


It seems to me that you might as well toss a coin and take your chances. Remember that under 3000 people are killed on our roads every year, but 30,000 are killed by doctors via mis-diagnosis and incompetence.

Doctors are dangerous. Always have been.

Peter McGrath said...

DOn't you stop your daily aspirin', 'cos one day you'll make somethin' of yourself Mr Dale. Don't let them anti-aspirin' Labour bastards grind you down.

Oh, you meant the pills? Dunno about anything that. Sorry.

iCowboy said...

As graybo says above. Keep on with them until your next appointment, then ask your GP what he makes of the research.

Are you only prescribed aspirin for diabetes? Or do you have any other condition - especially cardiac - where they might be of use?

................................. said...

Dr Iheanacho is a specialist; your General Practicioner is, well, a general practicioner.

Take your pick. Unless you're Alan Johnson of course, and don't much like taking the advice of specialists in a given field!

canvas said...

Iain, some doctors recommend taking a 'baby aspirin' daily - very low dose.

I think drinking a small glass of red wine each night would be more beneficial to your health! :)))

Mirtha Tidville said...

Can only pass on the advice of the Consultant that I see, for the same complaint as you Iain.Having studied the latest research, which has been extensive,he said unless you have a history of cardio vascular probs or if there is a particular need, then do not take aspirin as the risks are not worth it.
I`ve therefore stopped taking it.

Johnny Norfolk said...

Go talk to your Doc. Most of the people he sees are the worried well.

Dr John Crippen said...


Aspirin has never been thought to have a definitive role in primary prevention which is probably what you are taking it for. But there are exceptions to that and some (not all) diabetics are amongst those exceptions. Difficult to be precise without knowing all your medical background - and a blog is not the place to discuss that.

Once again, the meja has over-exaggerated a finding that is new to them but not new to doctors. Because it is new to them, they assume that they need to educate the medical profession.

Take a look at this from last year:


Then discuss it with your doctor. No one can answer your question in blog comments.

I wonder if your GP reads your blog? He is probably human, you know. Oddly, most of us are. So he may be a bit pissed off with you the next time he sees you.



rob's uncle said...

The Press Association have a good summary of what Dr Ike Iheanacho wrote in an editorial in Drug And Therapeutics Bulletin (DTB) at http://tinyurl.com/ybd8cta which concludes: ‘ . . June Davison, senior cardiac nurse at the British Heart Foundation, said: "It is well established that aspirin can help prevent heart attacks and strokes among people with heart and circulatory disease - so this group of people should continue to take aspirin as prescribed by their doctor. However, for those who do not have heart and circulatory disease the risk of serious bleeding outweighs the potential preventative benefits of taking aspirin. We advise people not to take aspirin daily, unless they check with their doctor. The best way to reduce your risk of developing this disease is to avoid smoking, eat a diet low in saturated fat and rich in fruit and vegetables and take regular physical activity."’

The most important thing, difficult though it is for many of us, is to get and then keep fit.

Simon Gardner said...

Lisbon Treaty now on: Cameron up shit creek.

Jonforest said...

Hedge your bets and halve your dose!
Katey, GPs may not like self-diagnosis using the internet but my wife still has the use of her bladder (and possibly legs and bowels) today only because she did just that.
Earlier this year, she woke up with a numb bum and couldn't pee very well. A look at the internet told her it could be a slipped disc pressing on a nerve (a condition that needs to be treated very quickly if the damage is not to become irreversible).
She went to our GP who diagnosed a bladder infection. She referred him to the internet articles and, fortunately, he decided to call our local hospital. Five hours and an MRI scan later, she was having emergency surgery, which proved successful as her functions and most sensation returned a fortnight later.
My wife is 32. While recovering, she spoke to a lady of similar age who suffered similar symptoms but was fobbed off first by her GP, then by an accident and emergency clinic for nearly a week.
She will never walk again, nor be able to use her bladder or bowels as nature intended. She confided that the only thing that makes life worth living is "the thought of suing the bastards" who would not listen to her.
I am not a fan of our litigation culture but, in this case, I wish her the very best of luck.
Feel free to mention this story to your GP next time he objects to you doing a little of your own research.

econyonium said...


It is taking a drug for no good reason that is the problem. In your case does the benefit of taking aspirin for your diabetes outweigh the risk of causing another problem?

Or put the other way are you putting yourself at greater risk by not taking aspirin than by taking it?

One of the problems is there is much talk about increased risk. The question to ask is what is the risk in the first place? For example, if there is a 1% risk (indicative not real) of bleeding anyway, and there is a 50% increased risk taking aspirin, this increase the risk from 1% to 1.5% hardly anything to get worried about.

Lord Lavendon said...

Forget aspirin, the best medicine is 1 Pint of Beer (Stout,Real Ale) or a nice glass of red wine (preferably Château Pétrus or Château Lafite) per day. Also
if you are feeling flush or in a good mood what about a good Havana (cigar)?

Gazzer said...

I don't know for a fact, but was the report commissioned by a drugs company by any chance? This is another example of "Reporting a Press Release". Next time you watch the news, look at the stories and see how many have resulted from reporting rather than just reorting a press release.

For Asprin, it's been known that it affects about 8% of people, mainly men with the worst condition being internal bleeding. If you are not one of the 8% you'll probably be fine, and I echo your earlier commentators -- Trust your GP

IvorBiggun said...

Just a few things going on today Iain, and all you've done so far today is use your readership for free medical consultancy!

P.S. And I see you've got rid of pseudo-anonymous commenting, and still have moderation enabled!

English First said...

What an incredibly naive thing to do ! Ask for medical advice on a Blog and discuss the merits of your GP! Outrageous!

For the record - Aspirin does NOT thin the blood, that is utterly inaccurate!

Mr. Mxyzptlk said...

I'd wait until tomorrow you might need several after Cameron's Humiliation

Scrobs... said...


Just stop pissing about and worrying if you're going to be ill.

Much easier that way.

Fight a bit harder eh?


John Woolman said...

Always look at the original paper rather than a journalist's rehash of a press release. Try and do it with this paper and what you get is: "This item is Restricted to Maintenance Users Only. Please sign in with your Maintenance user name and password".

No way am I basing advice to patients or what i do myself on the basis of press reports of a meta-analysis in a review journal.

javelin said...

Best advice - start eating from desert plates and weigh yourself every morning. The pounds will fly off once your realise those f@cking celebrity chefs are responsible for making the food delicious and you fat.

quietzapple said...

Of course you will listen to your GP. Quite right.

My late Grandma took asprin in what often seemed unconscionably large quantities until she died at 93.

If I have aches and pains I sometimes take paracetamol, asprin, ibuprofen in rotation and moderation in hope. My Dr says that is a reasonable strategy.

Are the asprin you take the mini does ones I understand are prescribed to forfend heart disease?

Gallimaufry said...

Just over 500,000 people die in the UK each year. In 2007 it was reported that up to 90,000 deaths each year may be linked to hospital blunders. Listen to your doctor but remember it is your life on the line.

javelin said...

I know alot about this sort of thing - and the best supplement on the market is in the US - called Protandim - 5 herbs. You can't get it in the UK - so I'm not selling it. It actually increases your natural anti-oxidants (1000s of times more powerful than Vitamin E etc) of SOD, CAT and HPX.

This is an article from the American Heart Association (the most presigious heart publication) this week.


Trevor Malcolm, Portsmouth, Hampshire said...

Medical patient Dale: variation on that old Hamlet chestnut that gave playwright, William Shakespeare, a headache ten-times the size of Stratford-upon-Avon, eh?

“ … To swallow aspirin, or not to swallow, … that is the question”

Doctors prescribing Aspirin Therapy? Maybe, say for the relief of aches and pains medical doctors assure us are the result of the ageing process. The nevitable signs of wear and tear on limbs, as we all shuffle nearer the geriatric fun-times, to enjoy becoming “ … a clump of dotty old dears, together … “

But I wonder, is all this talk of GI Bleeding, leading to ulceration, the problem of weighing up pros and cons, like long-term scratchings of our delicate stomach linings against the short-term palliative effect of relieving my aches, pains and agony, is it a healthy focus for the Tory Mind to focus on?

Or, instead of silted arteries and cardiovascular disease risk assessment and measurement, would we all feel better, heeding the mid-1990s advice of Dr Richard Carlson, instead? – ie, “don’t sweat the small stuff” and he then added “ … and it’s ALL small stuff … “

In your case, Patient Dale, now thinner and slimmer – yet another excuse for our champagne corks to pop, in further celebration – sure, you can still thumb through dear old Dr Vernon Coleman of Barnstaple’s books, with provocative titles like “How To Stop Your Doctor Killing You” because they contain medical advice, grounded in the application of common sense, not dubiously-funded, pharmaceutical industry-sponsored “studies” and biased research methods

Best advice would be, “first, stop fretting about it” – we even have a word to describe patients who worry. And still worry, even when they’re pronounced well and healthy. (Worry amounts to keep thinking incessantly, often negatively, but without much intention of taking action)

Oh, I promised you that word we have. Yes, it’s spelt F-O-O-L; yep, anyone who keeps worrying, that’s a fool for you, there

So, just eat up all those green veggies until your plate is clear and emptied. Good Boy, patient Dale. That way, you’ll become a lot more like the Government guidelines want us all to become

Trevor Malcolm
Portsmouth, Hampshire