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
See response 20...
Take a chill pill.
I might add that most people from 20 to 60 never have to see a Doctor at all (except for the persuasion of TV and others mercy, I have a cold - rushes to doctor). So Medical help really should be rare...
Wow...wasn’t trying to be rude, just factual... No need to be “chilling”...
Dang... I should at least ask “Are you a Doctor?”
Actually, I think annual checkups are a waste of time (medical and patient). You either have a problem and need medical attention or not. Annual or semi-annual checkups are another method of obtaining monies from the populous. It does work though - most seem to think that you have to have a checkup annually (great for the Doctors though).
That is another of the falsehoods being spread by those that gain. It actually costs more for everyone to do annual checkups than it does if no one does....but you won’t hear that because the money flows.... Yes, it may save the life of one in a thousand of less..but what the hey...
“if you actually want to live longer - stay away from doctors and hospitals at all costs”
I tend to agree. Every few years I will go to a clinic just to get a blood profile in order to see what my liver is doing, since I drink a lot of wine.
My LDL cholesterol has consistently been very high, but my HDL is also way above normal.
I am sure if I were back in the USA and with a regular doctor, he would probably insist that I go on some statin drug. My BP has always been text book perfect, no matter when or where I take it.
At age 64, I will let nature take it’s course.
I do take aspirin as a prophylactic treatment, but not on a religious schedule.
Well, you had better watch out... Either the Doctor will tell you of problems (need a prescription) or they will find a problem that you do not have...
At any rate, at least you are in good health now... If you stay from those Doctors, you will be even better...heh...
My Daddy lived an extra 21 years because instead of following your advice when his doctor told him to put his affairs in order and resign himself, he had his first (later scond and third) pacemaker implanted, which took place in a hospital by the way. He regularly took medication as prescribed, and he flourished thereby. He lived to see all his grandchildren grow up and to meet six great-grandchildren, because he did not follow your advice.
Because of modern medicine, Daddy lived longer than every one of his older brothers (his sisters lived into their 90s; the menfolk were dead by age 75).
You may want to discuss using ginkgo biloba with your doctor. It has anti-platelet aggregation properties and has a low side effect profile.
Plavix - probably not bad advice. It works on platelets through a different mechanism.
Warfarin - BAD advice. 10 minutes in the penalty box for unlicensed practice of medicine. Warfarin works on the Vitamin-K dependent clotting factors (II, VII, IX, and X) in the blood plasma, not on the platelets. No evidence whatsoever that it prevents heart attacks.
In case you were considering Heparin or it’s low-molecular analogs, they act on plasma antithrombin through its inhibition for factor Xa. So that doesn’t work well either.
I thought placebos were withdrawn from the market. At least, that’s what my GP told me.
I had a stroke when I was 49yo. Did I make a mistake going to the hospital? Should I quit taking my blood pressure medicine and let it get back up to 170 / 110?
I have a license. It was my second choice at 4 AM.
Warfarin works on the Vitamin-K dependent clotting factors (II, VII, IX, and X) in the blood plasma, not on the platelets. No evidence whatsoever that it prevents heart attacks.
Warfarin sodium, aka coumadin, is another drug that inhibits the formation of blood clots, i.e. anticoagulation. Unlike aspirin, you can't get it over the counter. Since it works on the Vitamin-K dependent clotting factors, it is very sensitive to diet. A doc prescribing it will require frequent blood testing.
In case you were considering Heparin or it’s low-molecular analogs, they act on plasma antithrombin through its inhibition for factor Xa. So that doesn’t work well either.
Heparin or it’s low-molecular analogs require daily injections.
"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."
Primary prevention reduces the risk of the first morbid event, in this case either ischemic stroke, aka ischemic cerebrovascular accident(CVA) or "heart attack," aka myocardial infarction. Persantine, aka dipyridamole, and Ticlid, aka ticlopidine, are other prescription, oral antiplatelet drugs.
Besides aspirin, I don't know if they have data supporting these other drugs used for the primary prevention of CVAs or myocardial infarctions. All of them increase the risk of bleeding complications such as ulcers and hemorrhagic CVAs. Hemorrhagic CVAs cause about ten to fifteen percent of strokes, but they tend to have a worse prognosis for those who survive them as opposed to ischemic CVAs which account for about eighty percent of strokes.
My apologies. Gotta watch that posting while sleep-deprived. I agree with you on aspirin. No one has published any studies that show Plavix or any of the other platelet inhibitors prevent events as far as I know.
I trained under Dr. Tinsley Harrison back in the 70's and he believed heparin would prevent recurrent cardiovascular events, so much so that he injected himself with it every day. He never had another heart attack as far as I knew, but he developed fairly severe osteopenia from the heparin and suffered several fractures due to it.
Thanks for the feedback.
Oh oh. What DID I start?
:)
Maybe he would have lived 42 more years if he followed my advice. One will never know.
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