Aspirin - prophylaxis (heart etc)

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#2092407 18-Sep-2018 11:01

I'm pretty sure that in NZ, advice from your GP (over the past few years) would be consistent with what the trial confirmed anyway.

But the enteric coated aspirin pills shaped like hearts are being marketed and available "off the shelf" with apparent suggested therapeutic benefit, people will self-medicate - when it seems more clear now - that many probably shouldn't. Medsafe could (IMO) look at that packaging, and perhaps change dispensing rules if they determine that's needed. IOW make it OTC dispensed by a pharmacist - rather than off the shelf.

MikeAqua

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#2092446 18-Sep-2018 12:10

Fred99:

But the enteric coated aspirin pills shaped like hearts are being marketed and available "off the shelf" with apparent suggested therapeutic benefit, people will self-medicate - when it seems more clear now - that many probably shouldn't.

Anyone who reads the instructions or talks to their pharmacist or GP should be able to ensure appropriate use. The pharmacists advice is usually free.

Appropriate use will change over time as new evidence emerges.

Mike

frankv

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#2092658 18-Sep-2018 16:15

I wonder what aspirin dosage the over-70s took?

The heart-shaped aspirin are low-dosage compared to normal aspirin. It may be that for over-70s, the low-dosage aspirin are better than *both* no aspirin and normal high-dose aspirin. I feel a medical PhD coming on...

Fred99

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#2092661 18-Sep-2018 16:18

robjg63:
MikeAqua:

Batman:

Scientists are weird.

They seem to have a swarm behaviour based on a simple mentality of something is either fully good, or fully bad. That something very complicated is either fact, or fiction.

Yesterday: Aspirin is good.

Tomorrow: Aspirin is bad.

You confuse science with media reporting of science. Media are weird.

If you read the primary literature you will find different scientists reporting different findings based on the data they analysed and the methods they used.

Overtime consensus emerges, but that consensus is always vulnerable to new evidence.

My advice - ignore popular articles about science and read the primary source.

This.
But more like "media are lazy" or "media no longer has the resources".
Once upon a time there used to be science reporters who had a background in science.
A proper research project will have a lot of material in its findings.
The media grabs a one sentence over simplified summation and that's what gets reported.

Once again - general conclusions about the media - which doesn't apply to the BBC article I linked to - which seems to be an accurate plain language report, with a link to the publication.

The headline 'Aspirin-a-day risky in old age' - major study' followed by 'Elderly people in good health should not take an aspirin a day, according to a major study in the US and Australia' is accurate.

Never mind.

Most people won't be able to read and understand the primary source - or have free access to it.

Fred99

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#2092662 18-Sep-2018 16:22

frankv:

I wonder what aspirin dosage the over-70s took?

The heart-shaped aspirin are low-dosage compared to normal aspirin. It may be that for over-70s, the low-dosage aspirin are better than *both* no aspirin and normal high-dose aspirin. I feel a medical PhD coming on...

100mg enteric coated. That's a low dose. The two "heart care" brands on my supermarket shelf are 75 and 100mg.

A standard "Disprin" tablet is 300mg.

And no - the low dose wasn't better than no aspirin.

FWIW ~7% of Australian and 37% of US participants reported that they had been regular daily users of Aspirin before the trial. Presumably that was without medical advice.

Batman

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#2092687 18-Sep-2018 17:09

The trial in question surprisingly is accessible. https://www.nejm.org/doi/full/10.1056/NEJMoa1800722?query=RP

1. 91% of the study subjects were Caucasians. So if you ain't no pakeha, look no further.

2. 100% of subjects have no known heart or brain blood supply problems. So if you have either, look no further.

3. 96% of subjects do not smoke (smoking => heart attacks and brain strokes). If you smoke ...

4. 89% have no Type 2 Diabetes (diabetes => bad). If you have Type 2 diabetes ....

5. The study found no difference in what they were trying to look for - ie disability-free existence. What a study is trying to look at is called the primary outcome.

*Which means whether you take aspirin or not makes no difference to whether you live a long and happy life.

6. The study had to find some other things to do so they also looked for other stuff, called secondary outcome.

*The first secondary outcome was death from any cause (bitten by a lion to run over by truck). THat showed a 95% chance of the hazard ratio lying between 1.01 - 1.29. A ratio of 1.0 is no difference. So saying there is an increase in death when it is possible that the ratio could be 1.01, is a bit rich.

*The second thing that they looked at which they did not design the study to look at, was "Clinically significant bleeding". Unfortunately it didn't say what kind of bleeding is "clinically significant". Nonetheless, there would have been little to no loss of life, as per the previous outcome result. They found that there was a 95% chance that the hazard ratio for clinically significant bleeding to be between 1.18 and 1.62. Now I don't exactly know what kind of math is a hazard ratio but it looks like less than twice the risk.

They stated that the serious bleeding risk was "2.4 serious bleeding events per 1000 person-years of exposure".

In fact many things I pointed out were in the discussion so just read the discussion bit. Including "In many trials, the use of aspirin was accompanied by a higher bleeding risk, without any clear indication of overall benefit or harm".

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Batman

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#2092708 18-Sep-2018 17:44

I also read somewhere that only 65% of all subjects took aspirin for the entire duration of the study. Need a bit more information before i can make any conclusion from that. Did they miss a pill for one day or did they miss 5 years.

Tinkerisk

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#2092928 19-Sep-2018 06:23

Isn't there a need to have too much red wine the day before the Aspirin? That makes sense. Wait - the PhD heart surgeon beside me confirms that without any studies ... don't have to ask her twice ... underway to the cellar right now (8:30pm here).

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Fred99

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#2092946 19-Sep-2018 08:09

Batman: I also read somewhere that only 65% of all subjects took aspirin for the entire duration of the study. Need a bit more information before i can make any conclusion from that. Did they miss a pill for one day or did they miss 5 years.

That's normal, a significant number of people don't comply. You don't need to make any conclusion.
Especially for drugs with more common / unpleasant side effects or if there's a less obvious immediate therapeutic benefit to the patient. Can be an explanation for results suggesting that drugs aren't working as hoped for based on clinical trial results where compliance was monitored. An unknown number of patients may get prescriptions filled but flush the medicine down the toilet etc - and don't tell anybody that's what they're doing - dispensing medicine doesn't mean it's being taken.

Fred99

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#2092948 19-Sep-2018 08:17

Batman:

They stated that the serious bleeding risk was "2.4 serious bleeding events per 1000 person-years of exposure".

I'm not going back to look at the paper - because you seem intent on pick apart something with such obvious bias - I give up - believe what you want.

I believe that the 2.4 figure was for the placebo group, for the group taking 100mg aspirin the figure was 3.8.

There was increased risk of a serious side effect - but NO reduction in mortality or incidence of conditions that the drug regimen was "supposed to" help prevent.

It was a very good study, published in a respected journal - yet half the comments in this thread have cynical bias - not "skeptical".

Batman

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#2092969 19-Sep-2018 09:17

Don't know what you're on about but every study no matter how good requires dissection about their internal validity. And every study no matter how strong its internal validity requires careful discernment about its external validity when applied to the general population. These are usually identified by the researchers themselves under "discussion" and "conclusion" segments, before being sent to the wolves, a process called peer review.

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#2092976 19-Sep-2018 09:32

Batman: Don't know what you're on about but every study no matter how good requires dissection about their internal validity. And every study no matter how strong its internal validity requires careful discernment about its external validity when applied to the general population. These are usually identified by the researchers themselves under "discussion" and "conclusion" segments, before being sent to the wolves, a process called peer review.

What? This wasn't published in a comic or journal of homeopathy. ROFL.

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#2093056 19-Sep-2018 11:07

Fred99:
Batman: Don't know what you're on about but every study no matter how good requires dissection about their internal validity. And every study no matter how strong its internal validity requires careful discernment about its external validity when applied to the general population. These are usually identified by the researchers themselves under "discussion" and "conclusion" segments, before being sent to the wolves, a process called peer review.

What? This wasn't published in a comic or journal of homeopathy. ROFL.

I'll just quote you in case you change your post.

MikeAqua

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#2093100 19-Sep-2018 12:44

Batman: I also read somewhere that only 65% of all subjects took aspirin for the entire duration of the study. Need a bit more information before i can make any conclusion from that. Did they miss a pill for one day or did they miss 5 years.

It's a key problem with studying people. They don't always take what they are meant to, and they start/stop increase/decrease things which confound results.

It's bad enough in clinical trials for medicine. Becomes even worse for foods such as eggs. Noise can quickly overwhelm any effect due to the product being tested. That why you get contradictory studies and inconclusive studies.

With animals it's much easier. Put some in cages, make every controllable aspect of their life identical - except for the one thing you want to test.

Mike

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#2093116 19-Sep-2018 12:55

Drifting off the topic a little: Yesterday I heard a snippet of a news item on the radio (Newstalk ZB) that said a study involving 1.2m people/patients has shown that there is no link between cholesterol and heart disease and that there is no need to take statin drugs to lower cholesterol - unless you’ve previously had a heart attack.

Edit: Found this online

https://metro.co.uk/2018/09/18/doctors-find-no-evidence-linking-high-levels-of-bad-cholesterol-to-heart-disease-7954636/

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