Posted on 09/25/2018 10:43:57 AM PDT by nikos1121
We shall not look upon his like again.
Only a touch of hyperbole here, as the results of the ASPREE trial flip everything we thought we knew about aspirin on its head and draw to a close a rough month for the willow bark–derived compound.
Some quick background: We've had data for decades that aspirin can prevent recurrent heart attacks and strokes—secondary prevention. And up until recently, mixed data leaned toward a benefit for primary prevention as well. The meta-analyses on this topic even suggested that there might be a benefit in terms of all-cause mortality and, tantalizingly, a reduction in the risk for colon cancer if you take aspirin.
Then everything changed.
Two weeks ago, we were treated to the results of the ASCEND trial, which looked at aspirin for primary prevention in 15,000 patients with diabetes.
While there was a modest benefit in terms of reduction in cardiovascular events, a fairly significant increase in the risk for major hemorrhage took the wind out of the sails of those results. Strike one.
Strike two was the ARRIVE study, a randomized trial of 13,000 patients with moderate cardiovascular risk. Aspirin had no effect on all-cause death or the cardiovascular outcome.
And now, strike three comes in the form of a trio of papers published in the New England Journal of Medicine, examining the results of the ASPREE trial. These studies paint an even bleaker picture for aspirin.
The ASPREE trial was a huge study, enrolling almost 20,000 individuals in the United States and Australia. It was targeted to older adults—over age 70—a group expected to be at higher risk for cardiovascular disease or death. The primary outcome was a composite of death, dementia, and disability, an effort to capture the fact that in an older population, simply living longer is not always the only goal.
Aspirin had no effect on the primary outcome. But the results get weirder. Looking just at all-cause mortality, the rate was higher in the aspirin than the placebo group.
Fortunately, absolute mortality rates were really low. It would suggest that for every 100 patients you treat with aspirin, you'll see one extra death over a 5-year period. This is tiny, but still, this is aspirin. What happened to the wonder drug?
Spurred on by these strange findings, the authors published their second paper in the journal, examining the causes of death. And the findings were driven by—wait for it—cancer.
The rate of new cancer diagnoses and death from cancer was higher among those taking aspirin compared with those on placebo. This runs counter to much of what we've been told about aspirin in the past.
What's going on? I suspect... nothing. And here's why.
Death was not the primary outcome in the ASPREE trial. We specify a primary outcome because we know that the more outcomes we test, the higher the chance we'll see a false positive. In fact, if you account for multiple comparisons in the ASPREE study, the "death signal" would not have achieved statistical significance. We would chalk it up to simple noise in the data.
Nevertheless, now we go down this rabbit hole and try to explain why death is higher. And what you have to realize here is that if we got a skew in death rates by chance alone, something would have to explain it; everyone dies of something. So the finding that it was "cancer" is not necessarily that weird either.
My number-one rule in medical research goes like this: One study doesn't prove anything. One study can suggest. One study can raise doubts, but one study never proves. So let's not jump on the aspirin-causes-cancer train. Too many prior studies conflict with that finding.
What we do have here, though, are multiple studies, in multiple moderate-risk populations, that all reach the same conclusion. Aspirin has no role in the primary prevention of heart disease.
Has something changed? Actually, yes. We are way, way better at preventing heart disease than we ever were in the past. We treat cholesterol and blood pressure more aggressively, and we manage diabetes much better.
In fact, all three of these trials share one other point in common (aside from the fact that they found that aspirin did essentially bupkis). They all dramatically overestimated the cardiovascular event rates they would see.
Our old risk equations aren't that good anymore, because we are doing a better job at reducing risk. And in this brave new world, aspirin appears to have lost its mojo.
So, aspirin, my old friend: Good night, sweet prince, and flights of platelets sing thee to thy rest.
Magnesium (among other things) for cardiac care. 2-3 times the RDA.
Despite the studies, wouldn’t it stand to reason that if your blood is thinner you would be less likely to form clots?
I don’t know. However I have been taking Aspirin everyday since 1984. Used to take 2 aspirin now only take 1 325mg per day. Either that take Xarelto!!
I’ll continue to take my daily Bayer 81mg aspirin.
When I look at these studies, I tend to think the pharmas are behind them and stand to make a lot of money pushing their pills on everyone.
I prefer a natural approach and tend to steer clear of the meds being pushed on so many people.
I take magnesium 3 times a day. When I work out, before bedtime and at 3 AM.
Agreed. I’m not going to stop taking it.
Yeah, but if you cut yourself you’ll bleed out...
Aspirin is cheap. By denigrating it’s effects you give the pharmaceutical companies an excuse to come up with a new patented pill that will cost an arm and a leg and will ultimately be proven to do less than what aspirin has done.
I’ll keep taking aspirin. I have had no side effects and most importantly I have had no heart attacks. I have a long family history of premature heart deaths. I’m still alive. Thank you Dr. Bayer.
I’d rather take an aspirin than warfarin or coumadin.
*********************
Amen to that.
.
Totally fake news!
Aspirin could drive the Quacktors broke. They hate it.
Natural substances are the only cures there are.
Quacktors and Commercial drug pushers are responsible for at least half of early deaths.
.
.
Warfarin or coumadin have no legitimate purpose.
Capsaicin does what they claim to do more effectively, and with complete safety.
.
.
>> “By denigrating it’s effects you give the pharmaceutical companies an excuse to come up with a new patented pill that will cost an arm and a leg and will ultimately be proven to do less than what aspirin has done.” <<
Amen!
And the cat that they really don’t want to let out of the bag is that aspirin can completely end insulin resistance safely for pennies a day.
.
I have taken a 81 mg daily until this year. I began when I was 54. I was in pretty good physical shape but surprising me, hypertension was showing up in all BP tests. I didn’t show a lot of blockage in stress tests but could not get BP lower without some BP medication daily. I was also told to take a 81 mg aspirin.
Now 15 years later, my BP is still fairly well controlled with daily medication but my wife’s cardiologist tells me that 81 mg aspirin is no longer viewed as a panacea.
Since both parents lived to about 90 and one had a stroke from a hemorrhage not a blockage, I have looked at the more recent studies and decided to quit taking aspirin.
Me too. 81Mg of aspirin isn't gonna get me. More likely it will be the Bleu cheese salad dressing or the bratwursts or the dark hoppy ale I love so. But...you're a long time dead so...bottoms up!
To spur continuing demand, prescription only. /sarc
Good point.
I’m going on 68 and in good health. But my family has a history of heart disease so I’ll continue. If it only serves as a placebo, so what.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.