Posted on 05/04/2009 12:28:27 AM PDT by neverdem
The U.S. Preventive Services Task Force has released the first gender- and age-specific recommendations for aspirin therapy in patients at risk of cardiovascular disease.
Drawing on data from recent studies, the new recommendations conclude that aspirin therapy reduces the risk of heart attack and ischemic stroke in appropriate male candidates, while it cuts the risk of ischemic stroke in female candidates. Both groups are at risk of gastrointestinal bleeding. Daily aspirin therapy therefore should be encouraged in women aged 55–79 years and men aged 45–79 years who have few risks of aspirin-related adverse events and who have potentially large benefits in terms of their respective risk reduction (Ann. Intern. Med. 2009;150:396–410).
The guidelines are the first update to government released recommendations on the topic since 2002.
Seven years ago, “we did not have enough data available to come up with more specific recommendations based on gender,” said Dr. Michael LeFevre, a member of the task force that wrote the document. “It was really the Women's Health Study that, when added to other studies, resulted in this very clear distinction in the benefits of aspirin in men and women.”
That study evaluated the risks and benefits of aspirin in the primary prevention of heart disease in almost 40,000 women. It reported a 23% reduction in the risk of ischemic stroke with aspirin use, but no significant benefit for heart attack.
Dr. LeFevre, a professor of family medicine at the University of Missouri, Columbia, said that the recommendations are based on an individual's risk.
For men, 10-year coronary heart disease risk factors include age, total and high-density lipoprotein cholesterol levels, blood pressure, and the presence of diabetes and smoking. Similarly, 10-year stroke risk in women is estimated on the basis of age, and the presence of hypertension, diabetes, smoking, history of cardiovascular disease, atrial fibrillation, or left ventricular hypertrophy.
Men and women older than 80 years should receive careful consideration, according to the guidelines. Although the incidence of heart attack and stroke is high in this population, so is the risk of gastrointestinal bleeding. “The net benefit of aspirin use in [these patients] is probably best in those without risk factors for gastrointestinal bleeding (those with normal hemoglobin levels, good kidney function, and easy access to emergency care).”
The risk/benefit ratio should be reassessed every 5 years. The document recommends a daily aspirin dosage of 75 mg.
The USPTF recommendations differ from those offered by academic societies, including the American College of Cardiology and the American Heart Association, Dr. Christine Laine said in an interview. Such groups recommend daily aspirin therapy in patients with a high risk of cardiovascular disease or a history of heart attack, but offer no age- or gender-specific recommendations.
“It's not a sea change from the previous guidelines, but it does take advantage of these newer studies to make more definite recommendations, and helps move the decision making from less certain to more certain,” said Dr. Laine, the senior deputy editor of the Annals of Internal Medicine and a general internist at Jefferson Medical College, Philadelphia.
The recommendations “set a new standard for guidelines,” said family physician Peter P. Toth. “There is a simplicity to the recommendations, yet the data supporting them were rigorously analyzed and appropriately interpreted,” said the director of preventive cardiology at the Sterling Rock Falls Clinic in Sterling, Ill.
Because the recommendations don't require a Framingham risk calculation, they will be much more appealing to busy primary care physicians, he said in an interview. Calculating the Framingham score “was strongly recommended by National Cholesterol Education Program Guidelines in patients with two or more risk factors. However, virtually no one does it, whether they practice in an academic or community-based setting, because it is perceived to be cumbersome and time-consuming.
PII: S0300-7073(09)70257-9
doi:10.1016/S0300-7073(09)70257-9
Yabut. What if a girl is allergic to aspirin?
*sigh*
It hurts when I do this, Doctor.
Well, don’t do it.
Aspirin is truly a miracle drug (I wouldn’t have my 3 living children if not for low dose aspirin) that was discovered well over a hundred years ago (and IIRC willow bark? was chewed for palliative effects going waaaaaaay back) that has been proven to have more and more positive uses as time goes by...OTOH, my father died at 39 from a massively bleeding ulcer (he also had other medical problems) when he was prescribed regular doses (325 mg) of aspirin for pain, and he took many a day...
As with all things, you need to be proactive in your own medical care, and not just rely on your doctor/s to tell you what you should do!
BTW, when I took LDA after my first child was born (and weaned) in hopes of getting pregnant again naturally, I was surprised to discovered that my chronic tinnitus disappeared! When I stopped taking the aspirin shortly before my twins were born, the tinnitus returned. I’m curious to find out what happens when I start taking the aspirin again after my twins are weaned!
I take an enteric coated 325 mg (5 gr) every day.
LOL!!!
(Lotta help YOU are!)
:)
Carp... Does anyone really fall for this? Medical evidence keeps changing pro/con no matter what the medicine. Sorry, but I have a much confidence in medicine as I do in hospitals and their infection rate... At your own risk...
My advice, just don’t take anything unless absolutely necessary. Okay, obey today’s advice, but be ready to to 180 degrees in a few months...mercy... They don’t have a clue anyway...
Oh, an simple things like aspirin are okay...don’t despair..
Try Plavix or coumadin, aka warfarin sodium.
Then don’t take medication - it is probably not needed at any rate. We are fast becoming a drug society... How about trying natural remedys...
You know, this seems like a good place to discuss medical practices...
If you go to the Doctor for a cold, the flu, and other common ailments (Oh gee, I have a headache), you are the problem! Almost all cases of these ailments are not only normal (in that they will progress their course), but going to the Doctor will only add to your cost and MINE! So Stop it!
I am 63 years old and have never gone to the Doctor except for broken bones (and even then, I should not have for fingers). I have not had health insurance for 45 years and can’t complain. Now why can’t most of the rest of you do the same and lower health costs?
Now I understand that the last years of my life are costly but I not only refuse to use Medicare but would urge others to do the same - save elderly costs. I understand that most of the health costs occur during the latter years and refuse to be a part of the problem. If others followed suit, maybe we could save enough to make it reasonable for our children... And...let’s not forget, if you go to the hospital, you chances of additional infection increases enormously...
I’d certainly salute you for having good genes more than anything else.
Medications sell because they more or less successfully address problems of less fortunate people. Most people can treat a cold or flu at home, but if it keeps up more than a week it’s wise to see a physician to rule out complications. If you get pink eye it’s better to get antibiotic drops than to risk going blind. Etc.
Um, 'cause we are sick?
Sorry to say that you are wrong... but it is not uncommon. I have had relatives that went to the hospital and suffered the consequences (usually caught something other than their original disease), so no...I say thank you to hospitals.
Now I can understand that some of the common remedies work for diabetes, headache, and other common problems, but if you actually want to live longer - stay away from doctors and hospitals at all costs... You will catch more that you originally had... This is one of the major “Universal Health Care” problems that you will forsake for possible care otherwise....
No not necessarily...but today’s medicine and doctors care prescribe the we do certain things...not altogether to ouw own good and certainly not to our benefit...
Doctors prescribe - we abide... Much to our dismay...
Right away you answer with strawmen so you can just go fiddle away in your room of homoeopathic treatments.
You know, what’s scary is that we all watch Dr. “What is” on TV and think that they know what they are doing...
If you actually followed medicine, you would find that many remedy’s have changed so much (and have backtracked to known cures) and most have gone back to what was understood (learned through trial and error) to cures that have existed for centuries. I am not including simple problems like headaches or even diabetes.
I have had relatives enter Hospitals with problems (usually minor) and exited with major problems (usually infections). Well, I can assume that entering the hospital is a dangerous proposition... Can I not?
If not... can I assume that when I get sick and require hospitalization that I won’t catch another disease that I did not enter with? I know, you still have faith in the medical system...so... well, I will let you decide...
At any rate, I do think that you are way too lenient toward the medical field or at least their concern for mankind.
Sorry, did not see any of those straw men you talk about...
Living a healthy lifestyle such as walking at least 5 miles a day, eating whole (natural) foods, using alcohol and caffeine in moderation while staying away from tobacco entirely will likely add many years to your life and keep you from poisoning your body with prescription drugs.
Of course the blind never see where they are going.
It’s not just that...The Doctors are looking to make money just like the rest of us. The prescribe (give away prescription medicine) to get you hooked and to make money. That is just the start unfortunately.
Most Doctors have contracts with their medicinal providers and tend to prescribe prescriptions accordingly... Just a fact - and it add to the expense of care along with unnecessary medicine... There is more...but I am tired of trying to persuade the stupid...health care lovers...
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