Low Dose Aspirin May Not Be Effective in Heavier Patients

Low-dose aspirin may not be effective in preventing cardiovascular events in people weight 70 kg (154 pounds) or more, a Lancet study suggests.

Researchers analyzed 10 trials that evaluated aspirin versus controls for primary prevention of cardiovascular events in 120,000 people.

Daily, low-dose aspirin (75-100 mg) was associated with reduced risk for cardiovascular events among those weighting less than 70 kg (odds ratio, 0.77), but there was no significant effect for heavier patients – roughly 80% of men in the study and nearly half of women weighted 70 kg or more. In the heavier group, low-dose aspirin may be even less effective in smokers and in those who take enteric-coated aspirin.

High-dose aspirin (300-325 or 500 mg), meanwhile, appeared to be effective in reducing primary cardiovascular events only [in] patients weight 70 kg or more.

Commentators said that people with more body mass may have more esterases, which clear aspirin and would reduce the bioavailability of the drug.

The authors conclude: “A one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required.

Protein in Aspirin May Reduce Alzheimer’s Disease Risk

Researchers have found that a key protein in aspirin may help pulverize an enzyme linked to neurodegenerative conditions like Alzheimer’s, Parkinson’s and Huntington’s diseases – suggesting that taking the common drug may help reduce American’s disease risk. In their research, published this week in the journal PLOS One, study authors at Johns Hopkins University and Boyce Thompson Institute discovered that salicylic acid, a byproduct of aspirin, binds to the enzyme GAPDH (Glyceraldehyde 3-Phosphate Dehydrogenase), preventing it from moving into a cell’s nucleus where it would cause cell death.

During oxidative stress, GAPHD is affected than enters the nucleus of neurons, where it affects protein turnover and leads to cell death, causing neurodegenerative loss. The anti-Parkinson’s drug Deprenyl [inhibits] GAPDH entry into the nucleus.

“The new study establishes that GAPDH is a target for salicylate drugs related to aspirin, and hence may be relevant to the therapeutic actions of such drugs,” co-author Solomon Synder, professor of neuroscience at Johns Hopkins University in Baltimore, said in the release.

In the current study, scientists also observed that a natural derivative of salicylic acid from the Chinese medical herb licorice and a lab-synthesized derivative bind to GAPDH more effectively than salicylic acid.

My Take:
This study hit several news outlets on December 1st. On Facebook, many people were touting the benefits of taking aspirin. Unfortunately, the information from this study has been misconstrued.

Let’s start with some history – Bayer began making aspirin well over a 100 years ago, trying to mimic the apparent benefits of White Willow Bark. Salicylic acid (SA) is a major component of White Willow Bark, so Bayer took acetone (nail polish remover) and combined it with citric acid (from citrus fruits) to make acetyl salicylic acid.

Tylenol ‘does not ease low-back pain’

Low back pain is the main cause of disability worldwide and acetaminophen (brand name Tylenol) is currently the first port of call in terms of reducing pain and speeding recovery.

However, a large randomized trial published in The Lancer investigates the efficacy of acetaminophen for acute low back pain and finds it performs no better than a placebo.

The researchers, led by Dr. Christopher Williams from the George Institute for Global Health at the University of Sydney, Australia, say their findings bring into question the “universal endorsement” of acetaminophen as the main painkiller for low back pain.

After conducting a systematic review of previous studies assessing the effectiveness of acetaminophen for low back pain, the team found no evidence to support its use. “All seven of the included trials had substantial methodological flaws, and only one trial included more than 25 participants per group,” they write. Additionally, they say no trial has compared acetaminophen with a placebo or compared dosing.

Their study randomly assigned 1,652 participants, of an average age of 45 years, with low back pain to receive regular doses of acetaminophen (3,990 mg per day) for up to 4 weeks; a second group was given acetaminophen as needed, and the third group a placebo. Results showed that between the treatment groups, there were no differences in the number of days to recovery; the median time to recovery was 17 days for the regular dose group, 17 days for the as needed group and 16 days for the placebo group.

Daily Aspirin To Prevent First Heart Attack Does Not Get FDA Backing

Does aspirin prevent heart attacks
Tuesday, May 6, 2014 (Medical News Today)

The FDA says while there is evidence that low-dose aspirin can prevent heart attacks, strokes and cardiovascular problems reoccurring (so-called secondary prevention), the case has yet to be made for using it to prevent a first event (primary prevention).

Aspirin works by interfering with the blood’s clotting action, so reducing the chance of clots developing and obstructing flow of oxygen and blood. Clots that obstruct a coronary artery can cause heart attacks, while blockages in the blood supply to the brain are a cause of stroke.

D. Robert Temple, FDA’s deputy director for clinical science, says for people who have not had a heart attack, stroke or cardiovascular problems, “the benefit has not been established but risks – such as dangerous bleeding into the brain or stomach – are still present.”

Neither does the data support the use of aspirin to prevent heart attack or stroke in people who have never had them but have a family history of them or are showing evidence of arterial disease, the report adds.
However, large trials looking at the use of aspirin in primary prevention of heart attack and stroke are ongoing, and the FDA will continue to monitor them and update consumers should the evidence change.

“The bottom line is,” say the FDA, “that in people who have had a heart attack, stroke or cardiovascular problems, daily aspirin therapy is worth considering.”

MY TAKE:
Aspirin was first marketed by the Bayer Company in 1897. It was developed to mimic the effects of White Willow Bark, an herb used to reduce inflammation. Salicylic acid was thought to be the active ingredient in White Willow Bark, so Bayer combined acetone (think nail polish remover) with citric acid to create aceto-salicylic acid – aspirin.

In wasn’t until 1994, when the chemical pathways for Aleve and Advil were discovered, that aspirin’s chemical pathway was also unraveled. It turns out, that the acetone is a Cox 2 inhibitor just like Aleve and Advil. The salicylic acid is not responsible for the anti-inflammatory effects in aspirin or White Willow Bark.

Subsequent research into White Willow Bark has failed to identify what chemical compounds account for its anti-inflammatory effects. Although it is often effective, I seldom use it as I want to know what chemical pathways I am affecting with treatment.

Aspirin, Aleve, and Advil cause over 16,000 deaths each year in the US. Most of the victims are over the age of 60 and less than a third has any warning signals. Most of them die from GI bleeds, but liver failure and heart attacks are the second and third most common form of death. By the way, the reference in this article to “bleeding in the brain” is called a bleeding stoke, so aspirin can cause strokes as well.

Daily aspirin does not really prevent heart attacks, strokes or pulmonary embolisms. It does however; reduce the risk of damage if such an event does occur. So there is some merit to its use.

THE BOTTOM LINE:
Indiscriminate use of aspirin, Aleve, or Advil can be fatal. Please discuss the use of these drugs with your physician. Look for contraindications and drug interactions with any other prescription drugs. If you have not had a heart attack or stroke, even with a strong family history, aspirin is probably not for you.