Friday, August 31, 2018

Daily Aspirin Unwise for Most

Taking a low-dose aspirin every day has long been known to cut the chances of another heart attack, stroke or other heart problem in people who already have had one, but the risks don’t outweigh the benefits for most other folks, major new research finds.

The research was discussed Sunday at the European Society of Cardiology meeting in Munich.

A Boston-led study gave aspirin or dummy pills to 12,546 people who were thought to have a moderate risk of suffering a heart attack or stroke within a decade because of other health issues.

After five years, 4% of each group had suffered a heart problem. One percent of aspirin takers had stomach or intestinal bleeding, mostly mild – twice as many as those on dummy pills. Aspirin users also had more nosebleeds, indigestion, reflux or belly pain. Bayer sponsored the study, and many researchers consult for the aspirin maker. Results were published by the journal Lancet.

Oxford researchers randomly assigned 15,480 adults with Type 1 or 2 diabetes but otherwise in good health and with no history of heart problems to take aspirin, 1 gram of fish oil, both substances, or dummy pills daily. After 7.5 years, there were fewer heart problems among aspirin users but more cases of serious bleeding, so they largely traded one risk for another.

The same study also tested omega-3 fatty acids, good oils found in salmon, tuna and other fish. Supplement takers fared no better than those given dummy capsules: 9% of each group suffered a heart problem. “We feel very confident that there doesn’t seem to be a role for fish oil supplements for preventing heart disease,” said University of Oxford’s Dr. Louise Bowman, study leader.

The British Heart Foundation was the study’s main sponsor. Bayer and Mylan provided aspirin and fish oil, respectively. Results were published by the New England Journal of Medicine.

My Take:
This is not new news about aspirin. It should not be recommended for primary prevention. However, I suspect Bayer was looking to show that people with diabetes, that have not yet had a heart attack,would benefit from a daily low-dose aspirin. Obviously, that is not the case.

The omega-3 fatty acid portion of the study is suspect. First the dose was too low. A minimum of 2 grams per day is needed to reduce prostaglandin inflammation, twice the study dosage. For cognitive improvement, a dose of 4 grams per day is necessary. Second, diabetics that are “otherwise in good health” is an oxymoron. Type 2 diabetes is an end-stage disease from metabolic syndrome that takes years of lifestyle abuse of diet and exercise to develop. Dr. Bowman has no real reason to “feel very confident” in her findings.

Bottom Line:
These studies reinforce the standard of medicine that states low-dose aspirin should not be used from primary prevention, even in diabetes. Unfortunately, PCPs (primary care physicians) routinely ignore these studies and recommendations, putting their patients at risk.

The conclusions reached about fish oil are not well supported by the study and should be ignored.

Source: August 28, 2018 The Palm Beach Post

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