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Can an Aspirin a Day Keep the Doctors Away?

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A new study shows that regular aspirin use reduces the risk of myeloma. Researchers from Brigham and Women's Hospital and Harvard University studied 2,395,458 person-years and showed a 39% lower myeloma risk among individuals with a cumulative average of more than 5 adult strength (325 mg) aspirin tablets per week.

Many details were reviewed and assessed as part of this carefully designed study.  A "4 year lag period" was built in to exclude patients who might have been developing myeloma in the 4 years prior to the study. Length of aspirin use was considered. Greater than 11 years of use gave the most benefit. Men appeared to derive more benefit than women.

But, as they say, "the devil is in the details." Researchers are always worried that something unforeseen may have skewed the results. Some previous studies have shown no impact from regular aspirin use. However, more recently, there are several reports of reduced risk of solid cancers (such as colon cancer) and lymphomas with regular aspirin use.

There is also a need to understand why the aspirin is working. In research lingo, the results have to be "plausible." There are indeed good reasons why aspirin can provide benefit. The anti-inflammatory and anti-oxidant effects involve key pathways such as NF-kB, COX-2, IL-6, and cyclin D1--all known to be important in myeloma progression. Chronic inflammation produces "free radicals" in the tissues, which among other things can damage DNA. Obviously, reducing or preventing chromosome damage is a very good thing.

This is a carefully designed study, but appropriately the authors advise "caution in the interpretation of our findings." Nonetheless, with something as simple as an aspirin a day, which provides many potential health benefits, the added value is worth considering. A key question is: "Can aspirin use reduce or prevent the activation of MGUS or smoldering myeloma into full blown myeloma?" A tantalizing question indeed!  Carefully designed prospective studies are definitely warranted.

It is not clear if a baby aspirin (as used to reduce cardiovascular risks) is sufficient or whether in the case of cancer, a full adult dose (325 mg) provides any additional benefit. Stay tuned for further details. I'm sure new research results will be coming soon.

In the meantime, check with your doctor and unless aspirin use is not possible or not recommended in your situation, "an aspirin a day to keep the doctor away" is perhaps an idea whose time has come while we await definitive long-term results!

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF Hotline staff instead. Specific medical questions posted here will be forwarded to the IMF Hotline. Questions sent to the Hotline are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate, but will not be posted here. To contact the IMF Hotline, call 800-452-CURE, toll-free in the US and Canada, or send an email to hotline@myeloma.org. Hotline hours are 9 am to 4 pm PST. Thank you.


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Thanks to the many of you who wrote in about Dr. Durie's blog on the reported effects of daily aspirin on prevention of myeloma.  Rather than answer each of you individually, as we normally do, we thought it best to add this addendum to the blog.

The medical article about daily aspirin use and the incidence of myeloma was certainly good food for thought and further research, but really raises more questions than it answers.  This is incidental data mined from a large study of male doctors over a long period of time. It was not designed to test any specific hypothesis about the long-term effects of aspirin at a given dose.
 
Here are some of the things we still don't know:
 
  • We don't know if aspirin merely lowers the risk of the incidence of myeloma, or if it actually has any anti-myeloma effect once a patient has been diagnosed.
  • We don't know whether the dose of aspirin is significant: in the study, the men taking the pill were using it for pain relief and were taking at least 325 mg (full-strength) daily.  Would 81 mg also be effective?  We have no data.
  • We don't know how much aspirin a person needs to take over what period of time to have an effect. Is the length of time of aspirin consumption--that is, the total cumulative dose--significant?  The benefits of aspirin only became apparent after many years of regular use in the reported study.  How much is enough?
Many times Dr. Durie blogs about interesting medical articles relating to myeloma or cancer research because they are good food for thought and for discussion with one's treating physician, and because they provide a new insight or a new theory that will lead to further research.  

Our present knowledge of daily aspirin use in the myeloma patient community relates only to its use as prophylaxis (prevention) of "venous thromboembolic events," or VTEs (ie blood clots) in a subset of patients who are receiving therapy with an immunomodulatory agent (IMiD, that is, Thalomid, Revlimid, or Pomalyst) AND dexamethasone.  All patients taking a combination IMiD and dex must be assessed for risk of blood clots by the treating physician, and treated according to published guidelines depending upon risk.  

Here is a link to the International Myeloma Working Group guidelines on prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma: http://myeloma.org/pdfs/DVTGuidelinesDec2007.pdf

Please note:
  • Aspirin in an NSAID (non-steroidal anti-inflammatory agent). Those who are not supposed to take NSAIDS, usually because of kidney issues, should not consider daily aspirin use. 
  • Use of aspirin or any other drug specifically to prevent blood clots during therapy with an IMiD alone (for example, during Revmilid maintenance therapy) is NOT recommended by the IMWG. 

11 Comments

I really don't know we should take 81-mg or 320-mg aspirin?

I am a 5+ year survivor of MM and am completely confused about taking aspirin. I have spoken to many specialists in the field and some say take only 81 mg of baby aspirin; some say take full strength (325 mg and others say they do not recommend aspirin at all while on maintenance Revlimid therapy.

I'm totally confused as to the right answer!!! It sounds like this is trial and error and no one has the absolute right answer!

Please comment!

Henry, you may wish to call the hotline, but from my own experience, it is very important that you talk with the specialist that is treating your myeloma and your primary care physician and make sure that they are talking to each other!

I was on 81 mg aspirin when I was on Revlimid because Revlimid can cause blood clots. But if you take another blood thinning medication while on Revlimid, it is very possible that you do not want to be on aspirin as well.

Aspirin can also upset and cause damage to the stomach and esophagus. So you may want to avoid it if you have those issues. This is why you want to make sure that your doctors are talking with each other as your myeloma specialist may not be aware of other medical issues that you that your primary care physician does (and vice versa).

Aspirin is an outstanding drug, but is not a benign one for those with GI and/or bleeding problems. Talk with the right doctors.

You are right, though, a lot of this does seem indeed like trial-and-error, because in a sense, it is. The report above was based on a study. If I recall these studies correctly, the participants self-selected whether or not they take aspirin rather than being randomized to it. People who self-select may be more health conscious to begin with which may also lower the risk of myeloma (healthier eating, less exposure to toxins, etc.). These are some initial (and promising) findings, but there isn't absolute certainty yet.

All the best to you!

I am also a 5+ year survivor of MM diagnosed March of 2008 and also confused about taking aspirin. I have been on 81mg aspirin throughout my treatment and continue on it after my Rev/Dex/Velcade maintenance therapy has ended.

How should I discuss this with my Doctors?

If I'm in remission with MM can adult aspirin help
Prevent it from progressing? I have been taking it
For almost 2 yrs now one adult aspirin a day?
Thanks for your help

reducing inflammation, NF-KB, IL6 ... this sounds really familiar to those of us who take curcumin... studies have shown that curcumin works this way as well.

Are there or have there been any studies using aspirin to prevent progression from smoldering myeloma to active myeloma?

Dr. Durie,

I am Smoldering MM and have been told not to use NSAIDS in order to preserve kidney function (my kidney values have always been WNL); I will use acetaminophen for pain relief/inflammation.

Since aspirin is an NSAID, how do we assess this new study info ? Is the thought the potential benefit might outweigh the potential risk of kidney damage?

Hope to hear a response from the IMF team ! Thanks so much.

Dr.Durie,
I hope to see you at the Boca Seminar this month.
lazy year in the breakout session you told me some very good news. I am smoldering since 2008 there is no and you said that the chance of becoming full blown lessens myeloma lessens with each additional year.
There are studies that the possibility of treating "early MM "
is being studied . The ASH 2013 has some info on that.
I am wondering your feelings on that thought.
Thank you,
Katherine Morgan

Six years cancer free following diagnosis MM treated with chemo and stem cell(own cells)transplant .Clinical trial thalidomide/prednisone 5 yrs. current drugs Coversyl 8mg,Rosuvastatin 10 mg , Aspirin 81 mg all once daily. Exercise three times weekly. blood pressure ok ,lower pulse rate. mental health good. Age 70 years 20 pounds over ideal weight. Wondering if anyone has thoughts or experience regarding Viagra or Cialis to share. Some say "caution " Thanks in advance of your response.

Dr. Durie:
Have you read Dr. Perlmutter's "Grain Brain"? He recommends a lot of the items you have suggested: aspirin or anything that reduces inflammation, reduce your blood sugar. Sleep enough. Exercise. as well as NO GLUTEN. I have been following most of his advice since November (hard to keep down the carbs! but I have been eating 85% chocolate...oh my)
--am on Pomalidomide (ok, Pomalyst) and my oncologist admitted to a "75% miracle" on my last visit.
I'm Kappa, double stem cell transplant (chemo/radiation at COH, Duarte), diagnosed 2007 (back collapsed--lost 3 inches-- hiked to the top of mt Hoffman 10,000 plus elevation2013 summer...) relapsed 2012 and had flavor of the month for the last 2 years...
Try his diet! Helped improve my recall and brain function after all the drugs.

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