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Ping!

I have another article to post about salt and diabetics. Again I say, every day something comes along to dispute what “everybody knew” the day before.

“I have another article to post about salt and diabetics. Again I say, every day something comes along to dispute what “everybody knew” the day before.”

That’s because statistical analysis and ‘outcomes research’ is not accurate enough to base medical practice upon. It is absolutely not evidence-based medicine, as proponents would have you believe. Large database studies are fraught with error, and the people who do them know that you have a better chance of getting published if you show something that is contrary to accepted practice, or if you show data that suggests that minorities or women are treated differently. It’s sad.

Again I say, every day something comes along to dispute what “everybody knew” the day before.

I have to disagree. From the Reuter's article:

"It refines our knowledge of how beneficial aspirin is," Dr. Graham Nichol, an expert in emergency care at the University of Washington in Seattle, said about the study. "I don't think this paper is inconsistent with previous work."
Nichols, who was not involved in the study, said aspirin is clearly beneficial for people who've already had heart disease, and that it also seems to help those at high risk.
"There is not universal agreement on what is high risk," he told Reuters Health. "In my mind, if you have diabetes or multiple risk factors for heart disease -- such as smoking or obesity -- it is reasonable to take aspirin."

There's no dispute about that. This was a meta-analysis, i.e. it's a pooled analysis of nine different studies that combined those with and without diabetes and otherwise healthy. Primary prevention means no prior history of myocardial infarction or ischemic strokes. It would not be good medicine to give aspirin to someone who already had a hemorrhagic stroke with aspirin's risk of bleeding, i.e. it's mechanism of action is the inhibition of platelet aggregation, aka inhibiting clot formation.

Meta-Analysis of Multiple Primary Prevention Trials of Cardiovascular Events Using Aspirin.

Several meta-analyses have focused on determination of the effectiveness of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention continues to be investigated. Nine randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial (BMD), the Physicians' Health Study (PHS), the Thrombosis Prevention Trial (TPT), the Hypertension Optimal Treatment (HOT) study, the Primary Prevention Project (PPP), the Women's Health Study (WHS), the Aspirin for Asymptomatic Atherosclerosis Trial (AAAT), the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial, and the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial. The combined sample consists of about 90,000 subjects divided approximately evenly between those taking aspirin and subjects not taking aspirin or taking placebo. A meta-analysis of these 9 trials assessed 6 CV end points: total coronary heart disease, nonfatal myocardial infarction (MI), total CV events, stroke, CV mortality, and all-cause mortality. No covariate adjustment was performed, and appropriate tests for treatment effect, heterogeneity, and study size bias were applied. The meta-analysis suggested superiority of aspirin for total CV events and nonfatal MI, (p <0.05 for each), with nonsignificant results for decreased risk for stroke, CV mortality, and all-cause mortality. There was no evidence of a statistical bias (p >0.05). In conclusion, aspirin decreased the risk for CV events and nonfatal MI in this large sample. Thus, primary prevention with aspirin decreased the risk for total CV events and nonfatal MI, but there were no significant differences in the incidences of stroke, CV mortality, all-cause mortality and total coronary heart disease.

There's no dose mentioned. Was it a baby aspirin, 75 or 81 milligrams(mg), "Halfprin" 162 mg or full dose 325 mg? We don't know. Aspirin also has a dose dependent anti-inflammatory effect.

Last time I checked, about a fifth of Americans are aspirin resistant according to the "bleeding time" test, IIRC.

Narrative Review: Aspirin Resistance and Its Clinical Implications

HOW COMMON IS BIOCHEMICAL ASPIRIN RESISTANCE?

We identified 5 studies investigating the prevalence of biochemical aspirin resistance (12, 48-51) (Table 3). The range of prevalence estimates for biochemical aspirin resistance varied from 5.5% to 56.8%, depending on the method of assessing platelet function, the definition of biochemical aspirin resistance, and the patients tested. These studies suggest that biochemical aspirin resistance is a measurable phenomenon in a substantial proportion of patients prescribed aspirin. However, the studies have several limitations (Table 3), including small sample sizes, lack of agreement between different platelet function tests, different dose regimens and nonadherence, and little information about measurement stability over time.

I could go on. No one questions the benefit of aspirin in the secondary prevention, i.e. a prior medical history, of myocardial infarction or ischemic stroke. The risk of internal bleeding is the main kicker, not to mention aspirin allergy.