What next for low dose aspirin?

Aspirin (acetylsalicylic acid) is inexpensive, readily available, and widely used for the treatment of many common conditions. Undoubtedly, its most important use now is in vascular disease as a daily low dose (75–150 mg) leads to a substantial reduction in the risk of a vascular event or death.1,2 However, the drug is also associated with undesirable effects, most notably gastrointestinal irritation and bleeding,3 which limit its use.

Evidence is now accumulating that suggests that aspirin may confer a risk reduction against a range of other chronic diseases, in particular against cancer4 and possibly Alzheimer’s disease.5 Because of the established benefits in vascular disease and these possible further benefits, aspirin would seem to have far reaching public health potential. So should it be more widely promoted?

This question was raised at a conference “The public health potential of aspirin in Wales” organised by the Welsh Aspirin Group (WAG) on 6 May 2004. WAG chairman Professor Peter Elwood suggested that a public health strategy to promote the use of low dose aspirin should be carefully examined. As with other preventive programmes, such as influenza vaccination, the strategy he proposed would have two arms: the targeting of high risk patients and a general population approach based upon age alone.

The present policy in Wales for the reduction of vascular disease involves only …