Aspirin for everyone over 50?

Editor—The case for the wider use of aspirin in vascular prophylaxis arises from the belief that subjects should be empowered to make their own decision about protecting their own health. This will be achieved only if information on the risks and benefits of preventive measures, including low dose aspirin, is widely available.

Granted, the numerical risk-harm balance of aspirin in trials based on subjects at low vascular risk is equivocal. If people are to be adequately informed, they should be told this, but they should also be told that the degree to which subjects in these trials were representative of the community is unknown. People should also be reminded that an evaluation of risks and benefits is also highly dependent on the seriousness and the consequences of the possible outcomes. In the end, people have the right to make this evaluation and decide about prophylaxis themselves, and enabling them do so is hardly passing the buck.

We caution against the use of enteric coated tablets and advise soluble preparations.¹ However, we find the paucity of evidence on the absorption and side effects of low dose aspirin in different formulations and taken in various ways worrying. Were aspirin still under patent, the available and new formulations would undoubtedly be fully investigated, but funding for such studies is unlikely to be available.

We reserve judgment on aspirin resistance. The relevance to vascular events of the usual platelet tests is doubtful.² Furthermore, most patients who would have been judged to be aspirin resistant show the expected responses when aspirin is taken under supervision.³

The suggestion that non-pharmacological approaches be considered is of wide interest. Most plants contain salicylates, and the reduced cancer risk in vegetarians is just one strand in the evidence from disparate sources suggestive of a reduction in cancer risk by aspirin.⁴,⁵