Monday, March 24, 1997 | 11:59 a.m.
WHEN A Massachusetts Institute of Technology survey gave 1,000 people a list of inventions and asked them to name the ones they "couldn't live without," the fifth-place finisher -- behind the automobile, light bulb, telephone and television -- was aspirin.
After 150 years of service as a pain reliever and fever reducer, aspirin truly is turning out to be a life-saver -- an inexpensive and powerful defense against heart attacks, strokes and even some forms of cancer. As scientific evidence mounts, millions of people at risk for those diseases have started taking low doses of aspirin daily.
But many people who should be on an aspirin regimen are not -- simply because their doctors failed to make the recommendation. In one recent study of heart patients, doctors prescribed aspirin to fewer than 60 percent of the men and 35 percent of the women who needed it.
Today's column discusses the preventive benefits of this inexpensive "miracle drug" in a wide range of disorders and may help you decide whether aspirin therapy might be right for you.
Heart matters
The strongest evidence of aspirin's effectiveness against major disorders comes from studies of heart attack and ischemic stroke. These events occur when a blood clot blocks an artery nourishing a portion of the heart muscle or brain tissue. By inhibiting the clotting process, aspirin helps prevent those attacks.
Aspirin's heart-protecting abilities were proved in 1988 in a large study of Harvard physicians aimed at determining whether aspirin could stave off first heart attacks. Researchers randomly assigned 22,000 male physicians, ages 40 to 84, to take either an ordinary 325-milligram aspirin tablet or a placebo every other day.
A striking development ended the study prematurely: 44 percent fewer heart attacks occurred in the aspirin group.
This and other studies established aspirin as essential therapy for most men who are at risk for a heart attack or who have already had one.
In 1991, Harvard researchers presented findings suggesting that aspirin held heart benefits for women as well. The researchers asked 90,000 women in the Nurses' Health Study about their aspirin use and tracked their health for several years. Those who reported taking one to six aspirin tablets a week had about 25 percent fewer heart attacks than those who said they took none.
In addition to its preventive value, aspirin has also been shown to help treat a heart attack, if taken promptly in response to symptoms. After calling for help, a heart attack victim should then take a regular aspirin tablet, even if he is already on aspirin regimen.
Brain protection
The evidence of aspirin's benefit against stroke is clearest for people who already had a stroke or a transient ischemic attack, a stroke-like episode causing symptoms that resolve fully within 24 hours.
Other benefits
* Colon cancer: Colon cancer is very common. It is rare in people under 40. But, after age 50, the risk doubles every seven years. Roughly one of every 20 Americans will develop the disease at some point in life. In 993, results from a six-year study of more than half a million people showed that those who reported using aspirin at least every other day for a year were about 40 percent less likely than nonusers to die of colon cancer.
* Migraine headaches: Aspirin does not relieve migraine pain, but both the Physicians' Health Study and a small British trial found that participants taking aspirin reported 20 to 30 percent fewer recurrences of migraine attacks.
* Influenza: Animal studies have shown that aspirin can boost the production of protective antibodies in response to flu vaccine. One controlled trial of 280 healthy people, 65 and older, found that those who took an aspirin just before and after receiving a flu shot were nearly five times as likely to develop high levels of antibodies as those who took a placebo.
Dosage
Recommended dosage ranges widely. A daily dose of 81 milligram -- which is the equivalent of a quarter-tablet -- may be the best for three reasons: The amount has been shown to have sufficient anti-clotting power, the low dose minimizes the risk of side effects, and a daily dose is easier to remember. It's possible that people at high risk for stroke might benefit more from a higher daily dose of 325 milligrams.
Ignore ads for Bayer boasting that it's "the only leading pain reliever that can help save your life." The key word is "leading" -- any lesser brand or generic version of aspirin will work just as well. What would be the price for one tablet a day for 30 days? A month's supply will cost a little more than $1.
Potential problems
The most common side effect is upper abdominal discomfort -- stomach pain, indigestion or heartburn. Bleeding in the stomach is a less frequent but more dangerous possibility. Researches conflict about whether enteric-coated aspirin -- now available in low-dose tablets Aspirin-Regimen Bayer, Ecotrin, Halfprin and other generic versions -- which dissolves in the small intestines rather than the stomach may help forestall these problems.
Finally, anyone taking aspirin who is scheduled for surgery, should consider going off the drug for a week or so before the operation and for a few days afterward to avoid any bleeding problems during surgery. All aspirin users should have a blood count done periodically to watch for anemia due to slow, unnoticed blood loss from the stomach.
If you seem to be a candidate for an aspirin regimen, don't leave it to your doctor to bring up the subject. But don't start an aspirin regimen on your own without consulting your doctor about the potential benefits and risk to you.
And finally, if you do go on aspirin therapy, don't neglect the important lifestyle changes -- such as exercising regularly, not smoking, and eating a healthy diet -- that can drastically reduce your risk of disease.
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