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New thoughts on 'An aspirin a day. . . '

Other than taking a brisk walk around the block, aspirin might be the cheapest way to improve your health. For just pennies a pill, aspirin is thought to prevent heart problems and possibly ward off cancer. And, of course, it helps with some kinds of pain.

But should you take one every day? The answer varies from person to person. To put it simply: It depends.

PROCEED WITH CAUTION

Anyone thinking about adding aspirin to their daily regimen should first ask their doctor if they're in one of the groups that definitely should (or shouldn't) take aspirin.

Dr. Stephen Green, associate chairman of cardiology at North Shore University Hospital in Manhasset, said most people with cardiovascular disease should take a low-dose 81-milligram aspirin (sometimes called a baby aspirin) each day. This group includes people who've had a heart attack, angina (chest pain) or a stroke, he said. It also includes those who've had a stent implanted.

But aspirin isn't a good idea for everyone who's had cardiovascular problems. Aspirin is a blood thinner, so people who take it may bleed more easily. That means those with a history of bleeding issues -- such as bleeding ulcers -- may not be good candidates for preventive aspirin because "the risk may outweigh the benefit," Green said. People on blood thinners like Coumadin (warfarin) also should be careful about taking aspirin.

Green said aspirin can also cause bleeding in the gastrointestinal tract and contribute to ulcers. "People who are taking other medications that might aggravate the stomach, like nonsteroidal painkillers -- Advil, Aleve, etc., but not Tylenol -- are at increased risk of bleeding with aspirin," he said.

Daily aspirin also isn't appropriate for people with congestive heart failure, said Dr. Daniel Chikvashvili, an attending cardiologist at NuHealth System-Nassau University Medical Center in East Meadow.

People who don't have heart disease and have no other conditions that make aspirin potentially more hazardous are caught between the do-take-it and don't-take-it extremes. What to do?

Doctors should first determine if you have more than about a 10 percent risk of developing heart disease over the next 10 years, Green said. If so, a daily aspirin might be a good idea -- although even then, he said, there's an exception for people older than 80 because they're more likely to develop gastrointestinal bleeding.

Chikvashvili recommends that men older than 50 take a daily aspirin, especially if they have high cholesterol or diabetes -- and women older than 60 take one, too.

POSSIBLE PERKS OF ASPIRIN

Among younger people, who may not have the cardiovascular issues of older people, a daily aspirin might seem appealing for its potential preventive benefits. Three studies published last month in The Lancet and The Lancet Oncology didn't offer conclusive proof but suggested that long-term use of aspirin could reduce cancer risks.

However, Chikvashvili said that physicians still don't believe the possible benefits for younger people outweigh the potential side effects of aspirin, which include bleeding, ringing in the ears and asthma.

Also, the cancers in question, such as colon cancer, tend to appear later in life, he said, suggesting that taking aspirin at a young age may not be helpful.

For those who do want to take a daily aspirin, Dr. Steve Rucker, an internist and kidney specialist at St. Francis Hospital's Heart Center in Roslyn, recommends the 81-mg dose in almost all cases. That dosage lessens the risk for gastrointestinal bleeding, compared with a full 325-mg dose, he said.

Rucker also said there's no reason to take brand-name aspirin instead of a cheaper generic version. But he does recommend coated aspirin, known as enteric, to lower the risk for bleeding.

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