If you've been told that ASA (acetylsalicylic acid), also known as aspirin, is only used for headaches, fever, pain, and inflammation, it might be time to update that information.
AAS is considered one of the most extensively studied drugs in the history of medicine. In addition to its traditional uses, scientists have been investigating various other potential benefits—though it is important to remember that none of these justify self-medication. All prescriptions must be tailored to the individual and administered under medical supervision.
Obviously, no medication can replace healthy lifestyle habits, which remain the foundation of prevention and treatment for virtually all diseases (as I explain in https://dominesuasaude.com.br/).
Its primary mechanism of action is the inhibition of the COX-1 and COX-2 enzymes, which reduces the production of prostaglandins, important mediators of inflammation. However, its systemic effects appear to go far beyond that.
It can HELP with:
✅Anticancer action (prevention and adjuvant treatment)
Chronic inflammation is one of the factors that contribute to the development and progression of various cancers.
By reducing COX-2 and prostaglandin E2 (PGE2) activity, ASA may inhibit mechanisms involved in tumor angiogenesis (the formation of new blood vessels) and in the suppression of the local immune response.
Observational studies and some clinical trials show a reduced risk of colorectal cancer with regular use of low doses in selected populations. There is also research suggesting possible benefits for breast, prostate, and esophageal cancers, although the evidence is still less consistent.
In some contexts, low doses are being studied as a possible strategy for promoting longevity and preventing cancer, but this decision must always carefully weigh the risks of bleeding.
✅Cardiovascular Health
ASA reduces platelet aggregation (“thins the blood”), thereby reducing the formation of blood clots.
However, current guidelines no longer recommend its routine use for primary prevention in healthy individuals, since, in many cases, the risk of bleeding outweighs the benefits.
On the other hand, in secondary prevention (for those who have already suffered a heart attack or ischemic stroke, or who have established cardiovascular disease), it remains one of the most important medications in cardiology.
There are also patients with a high risk of inflammation or thrombosis who may benefit from its use following an individualized medical evaluation.
✅Neuroinflammation, Cognition, and Mood
Today we know that inflammatory processes play a role in the development of neurodegenerative diseases and some forms of depression.
Because it reduces inflammatory mediators, ASA has been studied as an adjunctive treatment for treatment-resistant depression, bipolar disorder, and Alzheimer's disease.
Some studies also suggest an improvement in what is known as “brain fog” in individuals with high levels of systemic inflammation.
Although promising, this is still a field in the process of evolving.
✅May help reduce excess estradiol/estrone (estrogen dominance)
Prostaglandin E2 stimulates the enzyme aromatase, which is responsible for converting testosterone into estrogen.
By reducing PGE2, AAS may exert a modest inhibitory effect on aromatase in certain situations, a hypothesis that is still under investigation.
✅Mitochondrial function
Under certain experimental conditions, AAS can act as a mild mitochondrial uncoupler, increasing energy expenditure and CO₂ production.
Laboratory studies also suggest that it may stimulate mitochondrial biogenesis.
However, this effect is dose-dependent, and high doses can be toxic to mitochondria.
✅Erectile dysfunction*
By reducing endothelial inflammation and promoting the nitric oxide (NO) pathway, ASA may help improve vasodilation in some patients whose erectile dysfunction has a vascular or inflammatory component.
This potential benefit still requires more robust studies.
✅Possible antiviral and antifungal action*
AAS does not act as an antibiotic or as a direct antiviral.
However, by modulating the body's inflammatory response, it can influence the interaction between the host and certain infectious agents.
This mechanism is still being investigated.
✅Reduction in inflammatory stress*
Chronic inflammation and activation of the hypothalamic-pituitary-adrenal (HPA) axis often go hand in hand.
By reducing inflammatory mediators, ASA may help reduce this activation in certain clinical conditions, a hypothesis that is still being studied.
⚠️ Important Disclaimers
Self-medication with ASA—even at so-called “low doses” (81–100 mg)—can pose significant risks.
Among them:
- gastritis, ulcers, and gastrointestinal bleeding;
- reduced protection of the digestive mucosa due to COX-1 inhibition;
- a possible increase in intestinal permeability in some people;
- increased risk of bleeding, especially when used in combination with anticoagulants or other antiplatelet agents.
Long-term use may also alter the nutritional status of some patients and, in certain situations, may be associated with reduced levels of vitamin C, iron, folate, and potassium. When chronic use is indicated, it is worth evaluating on a case-by-case basis the need for monitoring and, if necessary, replenishment of these nutrients.
At high doses, ASA can cause salicylate poisoning. One of the first signs is usually ringing in the ears.
In addition, ASA should never be administered to children or adolescents with viral infections, due to the risk of Reye's syndrome, a rare but potentially fatal condition.
👉 Like virtually everything in medicine, ASA is neither a “villain” nor a “miracle cure.” It is an extremely interesting, inexpensive, and well-studied tool that can offer significant benefits when properly prescribed, but can also cause harm when used indiscriminately.
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