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Frank Bures: Should you still take low-dose aspirin?

Frank Bures: Should you still take low-dose aspirin?

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Nothing seems sacred. Nothing stays the same. When you have been given a medical proclamation from on high, it may be changed, revised, or even reversed.

This is precisely what happened to the decades-old expert edict that taking daily aspirin, mostly the baby 81 mg size, now called low dose, is necessary to help prevent heart attacks or strokes, neither of which anyone wants.

There have been many medical missives in the past year examining more recent studies to see how true the recommendation is.

One study published in a very recent issue of the journal Family Practice came from a doc and epidemiologist at the University of Georgia who collaborated with another doctor at the Royal College of Surgeons in Ireland to compare aspirin using patient data from 1978-2002, to four large-scale aspirin trials done after 2005.

Their synthesis of the data was that taking low-dose aspirin every day to prevent a heart attack or stroke should no longer be recommended to patients who have not already experienced one these “events.”

Part of the discussion is the possibility of the aspirin fostering bleeding either in stomach and intestine, especially in folks with peptic ulcer disease, or in brain.

Thirty years ago, when the pronouncement became sacred, statin drugs to reduce cholesterol were not around, and blood pressure control was not nearly as tight. Diabetes management now is more aggressive, and more colon cancer screenings are being done today.

All these contribute to prevention of stroke and heart attacks and colon cancer.

This study found that for every 1,000 patients treated with aspirin for five years, there were four fewer cardiovascular events and seven more major hemorrhages.

About 1 in 300 who took aspirin for the five years experienced a brain bleed. The tool being used currently to assess whether to give low-dose aspirin is a list of risk factors that somehow calculate a 10-year cardiovascular disease (CVD) risk score.

These include age, being male, being African-American, diabetes, history of high blood pressure, cigarette smoking, unhealthful cholesterol levels, etc.

You can visit a specific website, from the American Heart Association and American College of Cardiology, if you want to do your own risk evaluation. But, it doesn’t say you will have a heart attack. It is only a way to guess whether taking aspirin is worth risking the bleeding.

The controversy revolves around folks with no evidence of cardiovascular disease.

According to a Harvard affiliated cardiologist, “There’s no debate about aspirin use among people who’ve already had a heart attack or stroke, who have peripheral artery disease, or those who’ve had bypass surgery or a stent inserted into the coronary arteries. For them, aspirin is a cornerstone therapy. We accept the risk of bleeding because the risk of another heart attack, stroke or death is higher.” That’s from the expert. So what do the experts recommend? They show some difference of opinion.

The guidelines created by the AHA and ACC say aspirin is appropriate for ages 50-69 if sufficient CVD risk of 10% plus is present. The U.S. Preventive Task Force, an independent panel of national experts in disease prevention, says it’s only for ages 50-59 with over 10% CVD risk. The AHA counters, “The group’s recommendation is based on an imperfect risk calculator and statistics taken from older studies.”

In the far too numerous piles of carefully saved and squirreled way articles and journals in our domicile, I just rediscovered a newspaper article from 2015 with the headline “Ask about aspirin: help reduce heart attack, stroke”. It outlined a program designed by the University of Minnesota Medical School and other Minnesota medical entities called “Ask about aspirin.” Talk about getting medical whiplash from reading.

The same has been true of other zealous recommendations for things like taking estrogen for all post-menopausal women.

A Jan. 5 Star Tribune article discussed the breast cancer risk that might last decades from taking combination pills of estrogen and progestin hormones.

Can anyone else remember the miraculous zeal over vitamin E being able to cure anything for a few years? Oh, yes, and vitamin D had its day in the sun as the miracle du jour for a bit as well.

A couple final thoughts: for a long time Bayer brand aspirin held sway with its motto, “Four out of 5 doctors agree on Bayer aspirin.”

I recall a cartoon from the era with nurses in front of a television (with their nurse caps on) holding their sides laughing, with the caption, “When have you ever heard 4 out of 5 doctors agree on anything?”

Or the joke about the doctor answering a midnight phone call with the advice, “Take two aspirin and call me in the morning.”

I personally enjoy the line: an apple a day keeps the doctor away — if your aim is good and you throw hard enough.

Best advice is talk to your doc about aspirin.


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