While the specific problem arise from a planned surgery, the key point is how at risk we are due to slow blood clotting effect when compounding the effect of multiple supplements, regardless of planned surgery. An incidental trauma, would have a way greater risks with slow blood clotting than in a normal condition, so my key take is how to measure it and finally how to balance the benefit of existing stacking of multiple supplements bringing this unwanted behavior, given the implicit risks it does bring.
No.
As I previously posted:
“If aspirin were just now discovered, it would be considered one of the miracle drugs and would only be available by prescription. I have been a believer in aspirin for most of my life. I attribute the results of my colonoscopy to aspirin—zero polyps or cancer. I took 1 or two regular aspirin for much of my life. Now I only take “baby” aspirin.”
“The history of aspirin dates back more than 3,000 years, when people first discovered that the bark of the willow tree possessed fever-reducing and pain-relieving properties (Antoniadou et al., 2021). In 1763, Edward Stone, an English clergyman, systematically documented these effects (Wood, 2015). The breakthrough in aspirin’s development came in 1897 when German chemist Felix Hoffmann successfully synthesized acetylsalicylic acid, later known as aspirin, marking a significant milestone in pharmaceutical history. Decades later, British pharmacologist John Vane elucidated its mechanism of action, revealing that aspirin exerts its effects by inhibiting the synthesis of prostaglandins. Recognized as one of the three most iconic drugs in modern medical history—alongside penicillin and diazepam—aspirin has played a pivotal role not only in pain management and anti-inflammatory treatment but also in the prevention of cardiovascular and cerebrovascular diseases.”
Aspirin and Colorectal Cancer Risk Reduction
- Garfinkel & Thun — American Cancer Society (NEJM, 1991)
One of the earliest and most influential studies. In a prospective mortality study of 662,424 adults, death rates from colon cancer decreased with more frequent aspirin use in both men and women. The relative risk among those who used aspirin 16 or more times per month for at least one year was 0.60 in men and 0.58 in women New England Journal of Medicine — roughly a 40% reduction.
Rothwell et al. — Pooled Analysis of Randomized TrialsA landmark pooled analysis of four randomized controlled trials found that treatment with any aspirin dose between 75 and 500 mg/day reduced the 20-year risk of colon cancer by 24% and colorectal cancer-associated mortality by 35%, with increasing benefit observed with longer durations of treatment. REF
Nurses’ Health Study (NHS) Analysis
In an analysis of the NHS, regular aspirin use was significantly associated with a 28% reduction in risk of death from colorectal cancer, a 12% reduction in risk of death from any cancer, and a 25% reduction in risk of death from all causes.
Figueiredo et al. — Cedars-Sinai/ACS (JNCI)
Long-term, regular use of baby aspirin — at least 15 times per month — prior to a diagnosis of colorectal cancer may reduce the risk of death from the disease by limiting the spread of cancerous tumors pre-diagnosis, according to a study published in the Journal of the National Cancer Institute
Aspirin might even prevent some recurrences of colon cancer:“AsFor patients with stage I, II, or III rectal cancer or stage II or III colon cancer with PI3K pathway driver alterations, daily treatment with 160 mg of aspirin for 3 years reduced recurrence rates.” REF2,
The caveat:
“While the evidence is substantial, aspirin carries risks — particularly gastrointestinal bleeding. The individual risk of taking aspirin (especially the bleeding risk) should be discussed with a primary care provider for each patient before using aspirin for colon cancer prevention. Patient Power: Anyone considering aspirin for cancer prevention should consult their physician first.”
My most recent colonoscopy, just a few months ago, found only one small benign polyp which was removed.
The doctor said I had one of the cleanest colons he has seen in anyone my age. Can’t prove it, but I attribute it to a lifelong regular use of aspirin. Fortunately, I have never experienced any internal bleeding.
“The overall incidence of GI bleeding with low-dose aspirin was approximately 1.39 events per 1,000 person-years in men and 1.67 events per 1,000 person-years in women.”
As I said, if aspirin were just discovered, it would be a miracle drug.
Other proven and studied benefits of regular aspirin use.
Secondary Cardiovascular Disease Prevention (Heart Attack & Stroke
Cardiovascular Prevention in Diabetics (ASCEND Trial)
Etc., etc.
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@desertshores you’ve presented a good case but I would question most of it. The bottom line is currently no medical organization recommends use of aspirin to prevent colon cancer.
For anyone that thinks aspirin is a miracle drug, there is another person that says it wouldn’t even get FDA approval if it were discovered today.
Your study is > 30 years old. Many studies have been done since. Some show benefits in select groups for colon cancer, but not in general and not if started late in life. The risks are significant, especially in the elderly.
And unfortunately, even though your personal experience has been good, it’s just an n of 1.
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@KarlT fwiw, I’ve always heard it would never be approved today. (In the verrrry olden days I was a pharma rep and would hear it from doctors)
I do take it daily but only because I’ve been told to by multiple cardiologists.
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FWIW…
Published 2 years ago.
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Thank you @Joseph
I KNOW!!! It’s overwhelming!!!
On paper, I have all the risk on paper for an MI (shared above re my apoe3/4, high CAC, high lp(a), scary family history)
What I don’t understand well enough, but….
If I should get a CCTA with Cleerly, and if things look good under the hood, does that show low risk and therefore eliminates the need for the daily aspirin … or, if you have a high CAC score and high lp(a), do you always have greater risk??
These are the nuances I don’t really understand. A bleed seems better than an Mi. But maybe with a good CCTA result, at min, maybe you reduce the daily aspirin dose?
I don’t want to get the CCTA unless there is something actionable I’m going to do with the info. I’m already aggressively working on my lipids.
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I have never suggested that anyone else should be taking aspirin. That is for them and their doctor to decide.
I am not sure why there is such a propensity among certain forum members to jump on a single article that seems to refute the preponderance of research.
For instance, we still have people ignoring the benefits of statins. We have some who refute that lower is better for cholesterol.
The particular article that @joseph cites is an example. Though he did include the caveat FWIW.
Key Weaknesses of the Study
-
Short follow-up period At 4.7 years median, the trial may have ended before aspirin’s known cancer-protective effects could manifest. The study authors explicitly acknowledge this as the “principal limitation.”
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The cancer signal crossed multiple comparisons without adjustment The study analyzed many secondary endpoints (cancer death, cardiovascular death, hemorrhage death, etc.). When you test many outcomes, the chance of a false positive increases. The authors admit the confidence intervals were not adjusted for multiple comparisons, which weakens the statistical validity of the cancer finding.
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The all-cause mortality result was borderline A hazard ratio of 1.14 with a lower CI of just 1.01 is barely statistically significant. Had the trial run slightly differently or enrolled slightly fewer people, this would not have been a “significant” finding at all.
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Specific to a narrow, healthy population Participants were pre-screened to exclude cardiovascular disease, dementia, and disability. The healthy trial volunteers had cancer mortality rates only 49% of the general population — making it harder to generalize results to typical elderly patients.
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Geographic anomaly The increased mortality appeared concentrated among Australian participants, with little effect seen in the U.S. group. The authors note this interaction (p=0.02) but cannot fully explain it. This raises the possibility that the result was partly a statistical artifact or driven by unmeasured country-specific factors.
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Biological plausibility is uncertain The authors cannot explain why aspirin would increase cancer deaths. The excess wasn’t confined to any specific cancer type, which is unusual if there were a true biological mechanism. A scatter effect across cancer types is more consistent with a chance finding.
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The trial was stopped early The trial was halted at the request of the NIH because aspirin showed no benefit on the primary endpoint. Trials stopped early can sometimes produce misleading results in secondary outcomes, since stopping rules are built around the primary endpoint.
Bottom Line
This study provides a real but fragile signal that daily aspirin may increase mortality in healthy elderly adults, primarily through cancer. However, several important cautions apply:
- The absolute risk difference is very small (~1.6 deaths per 1,000 people per year)
- The statistical significance is marginal and not corrected for multiple comparisons
- The follow-up may have been too short to capture aspirin’s known long-term cancer-protective effects
- The result conflicts with the broader body of evidence showing aspirin’s anti-cancer benefits
- The finding is biologically puzzling since no specific cancer type drove the effect
The study is valuable and raises legitimate questions, particularly about whether aspirin recommendations should differ for elderly vs. younger populations. But its results alone are not sufficient to overturn the larger body of evidence — which is exactly why the authors urge readers to “interpret with caution.”
Detection bias or chance
Cancer deaths were:
- 3.1% in aspirin
- 2.3% in placebo
That is an absolute difference of 0.8%.
Small differences like this can occur by chance, especially with multiple secondary analyses.
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I’d consider changing from low dose aspirin to clopidogrel (Plavix) monotherapy. Risk of pathological bleeding (specifically intracranial and GI bleeding) is lowered while offering better protection against MACE. Clopidogrel versus aspirin for secondary prevention of coronary artery disease: a systematic review and individual patient data meta-analysis - PubMed
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My cat was on this but this is the first time I’m hearing about it as an alternative to baby aspirin… great find!!!
It clearly says it does a better job at reducing the chance of an MI, but I think I’m reading the bleeding risk is the same? (Still a win, but will you double check).
I’ll send this to my doc.
I think overall bleeding risk is similar, but mainly GI bleeding risk is lower since clopidogrel doesn’t irritate the GI tract. I for one can’t tolerate even baby aspirin for any period of time due to stomach pain, but clopidogrel was never an issue.
One thing that might be worth doing before changing to clopidogrel is a blood test for CYP2C19 since full function of this enzyme is required to convert clopidogrel into its active form, and loss of function genetic variants can inhibit this conversion. I know routine testing isn’t recommended currently on a population-level when prescribing clopidogrel, but it’s something I had done because it was easy and fairly cheap and it could mean the difference between a heart attack and no heart attack.
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I disclosed everything I’m doing to a surgeon. I’ve not had my first meeting with him yet but I’m very interested to see his reaction haha. I imagine a mixture of horror and curiosity.
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After my first TAVR, the cardiologist told me to take a baby aspirin every day for the rest of my life no matter what. So far surgeons have always yielded to the cardiologist, even on the day of surgery. For a couple of days before the surgery, and following my own advice, I add extra Vitamin K to the stack. Thus far no one has reported any excess bleeding.
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@garym37 thanks for sharing. I never knew about vit k in how it relates to baby aspirin, but I started taking calcium last year, so I now take a ton of k to hopefully help keep it out of my arteries
you better. serious issues can arise during cataract surgery due to meds/supplements taken.
why not consider a CAC? no need for an IV like a CCTA.
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I seem to recall that afib was a concern at 5 grams and over. But I am alert to any heart flutters and haven’t noticed any. I’ve had more of a “visible” problem with aspirin, but at everyother day I do pretty well. So I use both fish oil and aspirin after a mental cost/risk/benefit analysis, not academic or rigorous, just mulling over the pros and cons that I’ve read about. Same rationale/process I used deciding on sglt2,astazanthin, creatine, glycine and others, and yes even rapamycin. And I change my mind from time to time. Aspirin and fish oil are pretty old timers for me, so it would take pretty solid negative evidence to sway me.
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@sudiki
Yes, the invasiveness of the CCTA is why, even though I ponder doing it, I haven’t yet pulled the trigger. I’m already aggressive in medical management and lifestyle/diet, so I say there is no reason for me to do it because it wouldn’t change what I’m dong.
I already know I have a very high CAC score. The reason I was thinking out loud on the CCTA is that maybe now that I’ve been aggressively treating my lipids for many years, perhaps there is a chance I don’t have much soft plaque anymore… I don’t know if that is even possible. But if that is what it showed, then maybe that means I’m no longer high risk and could stop the daily baby aspirin?
What I don’t know is even if I happen not to have a lot of soft plaque, would I still be high risk due to a lot of calcified plaque that would warrant staying on it. I don’t understand it enough.
talk to your cardiologist. from what i know/understand the hard kind is better than the soft as it can’t rupture as easily.
You are correct, I do know that to be true. I think that is one of the benefits of statins… that it helps stabilize them.
The cardiologist just says do a stress test… I know I’ll pass that with flying colors, so I don’t want to spend the money… last one I did cost me 11k!