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Aspirin About-Face

davidepstein.bulletin.com

1–10 of 31 posts

Re: Aspirin About-Face

#2
I would love to see this analysis for statins.

On a slightly related note, it seems many people don't know (aren't being told) the risks associated with not taking a drug and taking it. It seems like is just "the FDA ruled the benefits out weight the risks" and that gets applied to everyone. Just like generally safe is often misinterpreted as completely safe.

Re: Aspirin About-Face

#4
post #2

I would love to see this analysis for statins. On a slightly related note, it seems many people don't know (aren't being told) the risks associated with not taking a drug and taking it. It seems like is just "the FDA ruled the benefits out weight the risks" and that gets applied to everyone. Just like generally safe is often misinterpreted as completely safe.

It also feels like with statins, that the standard of when to take the drug is some kind of Overton window. If the FDA rules that that it's worthwhile for people with diabetes, then it gets prescribed for people at risk of diabetes, then for people at risk of pre-diabetes, then it gets prescribed for people who may be at risk of pre-diabetes, then it gets prescribed for people wanting to be precautious of potentially being at risk for pre-diabetes, and so forth.

Re: Aspirin About-Face

#5
post #2

I would love to see this analysis for statins. On a slightly related note, it seems many people don't know (aren't being told) the risks associated with not taking a drug and taking it. It seems like is just "the FDA ruled the benefits out weight the risks" and that gets applied to everyone. Just like generally safe is often misinterpreted as completely safe.

This. Even this recommendation change referenced blood thinners and statins of which researchers beg doctors to weigh use against accelerated muscle degeneration.

Re: Aspirin About-Face

#6
"That means if 1,000 elderly women take aspirin daily for a decade, 11 of them will avoid a heart attack; meanwhile, twice that many will suffer a major gastrointestinal bleeding event that would not have occurred if they hadn’t been taking aspirin."

"The U.S. task force wants to strongly discourage anyone 60 and older from starting a low-dose aspirin regimen, citing concerns about the age-related heightened risk for life-threatening bleeding."

I understand that the bleeding is a serious concern, but does that have an immediate, potentially fatal or life changing impact - or does it happen with enough warning that you could stop taking aspirin and/or get medical assistance?

If so, then I think most people would feel that is worth the risk to take aspirin even though it has a more numerically higher likelihood of a bad outcome.

Re: Aspirin About-Face

#7
This is surprising for 2 reasons

1) that there was this significant bleeding from baby aspirin

2) that a miracle drug from 300bc is being found to have downsides.

I'm still an aspirin proponent for treating sunburns and minor ailments. And salycilic acid for my face routine.

Fish oil's recent science on hormone regulation and inflammation reduction should make it a first stop.

Then there is AKG.

Re: Aspirin About-Face

#9
It would be interesting to learn whether some other forms of treatment or drugs have appeared in the years people have been taking daily aspirin. The article makes it sound like "whoops we've been wrong all these years, sorry for all the bleeding" but in reality the risk balance constantly shifts so what made sense for great-grandma may not make sense for grandma.

Re: Aspirin About-Face

#10
This piece entirely misses the point of the recommendation.

The new recommendation is that aspirin should not be used to prevent heart attack in those without a history of heart disease (ie avoid routine aspirin for "primary prevention"). Aspirin for primary prevention has always been a grey area. The reversal came after a large trial in the New England Journal of Medicine looking at this. The trial showed the decrease in cardiovascular events was balanced by a similar increase of bleeds. So it's still grey because some people would prefer to bleed because blood is easily replaceable, your heart is not.

What remains clear is that people who have had heart attacks, strokes, or peripheral arterial disease should in most cases continue their anti-platelet agent.

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