Aspirin - prophylaxis (heart etc)

Forums › Health and fitness › Aspirin - prophylaxis (heart etc)

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MadEngineer

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#2093122 19-Sep-2018 13:18

Met a guy who had a stroke after being miss-diagnosed. He was a machinist on a work permit so consequently lost his job and his home and independence. Dream of life in NZ finished.

Tragically, a simple aspirin may have helped him.

Don’t take your health lightly, always get second opinions and get proper professional medical advise.

You're not on Atlantis anymore, Duncan Idaho.

eracode

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#2093125 19-Sep-2018 13:22

But wait - there’s more! Study finds salt is actually not all that bad for you:

https://www.newstalkzb.co.nz/news/health/study-finds-salt-isnt-actually-that-bad-for-you/

Sometimes I just sit and think. Other times I just sit.

Tinkerisk

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#2093174 19-Sep-2018 14:31

You'll find any study pointing either in this or that direction.

Fake news? https://phys.org/news/2018-07-beware-scientific-studiesmost-wrong.html

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eracode

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#2093270 19-Sep-2018 15:52

Tinkerisk:

You'll find any study pointing either in this or that direction.

Fake news? https://phys.org/news/2018-07-beware-scientific-studiesmost-wrong.html

What about “Warning that ‘warnings that studies mostly wrong’ are mostly wrong”?

Sometimes I just sit and think. Other times I just sit.

Fred99

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#2093273 19-Sep-2018 15:53

MikeAqua:

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.

Even moreso when you're researching the effect of behaviours, "double blind" isn't possible, and the behaviour has known (to the participants) negative or positive correlation with some outcome.

For example - self-reporting of exercise or alcohol consumption.

As for the Aspirin double-blind trial as subject of the thread, there's an ethical consideration if the trail was to be repeated. The evidence is compelling that in those subjects (healthy and over 70) aspirin causes harm, and no evidence it does any good (at least WRT to CVD prevention)

Fred99

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#2093281 19-Sep-2018 16:08

eracode:

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/

I don't even think that's particularly new news.
AFAIK there's basically irrefutable evidence that high cholesterol and heart disease strongly correlate, and there's irrefutable evidence that statins reduce LDL cholesterol very effectively.

But the evidence that reducing that high cholesterol with statins reduces overall mortality ain't so great. Which is why any doctor - whether prescribing statins or not - should be having a good long hard chat to the patient about family history, lifestyle, exercise, weight, diet etc. Then of course you'll end up in a sh&t-fight about what constitutes a "good" lifestyle, what's "overweight" or "obese", and what food is good , what's bad and why. You can of course get "expert" opinion on that everywhere. A bottle of pills seems much easier - just so long as they work.

Tinkerisk

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#2093318 19-Sep-2018 17:21

eracode:

What about “Warning that ‘warnings that studies mostly wrong’ are mostly wrong”?

Well, good question. Maybe flipping a coin?

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Batman

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#2093528 19-Sep-2018 23:01

Tinkerisk:

You'll find any study pointing either in this or that direction.

Fake news? https://phys.org/news/2018-07-beware-scientific-studiesmost-wrong.html

It's because many so called scientists, including our resident scientist here, do not understand the process of science and critical analysis of scientific research. They see one study and immediately know that is the bottom line.

The thing about this aspirin issue (in medical terms, it is called "aspirin in the prevention of primary cardiovascular disease") is that it has been studied many many times before, totaling somewhere around 300,000 subjects. The latest study is just, the latest study. And naturally, everybody now suddenly knows something they didn't before, after previously studying 300,000 subjects.

Unfortunately in scientific research, one study is never the bottom line. That's why most studies are wrong. You need a collection of studies to begin to understand something. THat's why people probably never understand anything.

One good study in the eyes of the National Health and Medical Research Council of Australia counts as Level 2 evidence. (Highest level of evidence is Level 1).

Fred99

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#2093540 20-Sep-2018 00:54

I do hope you're not referring to me as "resident scientist". I left school at 12 (expelled). If so - how dare you. Regardless of that, I did work for a while for the largest aspirin and paracetamol manufacturer in the world at the time, the money was very good, but I still know nothing.

You mention Australia - here are the current AMA guidelines:

Aspirin and other antiplatelet agents are no longer routinely recommended for use in primary prevention of CVD, including for people with diabetes or high absolute CVD risk. Previous recommendations for people with diabetes were based on the assumption of equivalent CVD risk to those with established CVD but without diabetes.11 However, recent primary prevention trials in patients with diabetes have not shown benefit for aspirin.12,13 Harm–benefit analyses of antiplatelet drugs for primary prevention assume that risk of CVD rises with age but risk of adverse effects does not. While it is true that CVD risk is largely determined by age, the risk of adverse effects is also likely to be higher in older people.14 An ongoing clinical trial, Aspirin in Reducing Events in the Elderly (ASPREE), is being conducted in Australian general practice to examine whether the benefits of routine aspirin outweigh the harms in patients aged 70 years or older.15

Presumably, as the result of the trials I've highlighted above - which was not coincidentally the trial I posted about to start this thread - those guidelines will be amended. You seem to think I've cited something from a Sunday paper.

The tablets in question (low dose enteric coated aspirin) are freely available on the supermarket shelf in NZ, very clearly labelled with a simple therapeutic claim. For example "Cartia helps prevent blood clotting and reduces the risk of of heart attack and stroke".

Yes there may be "fine print". That's not really acceptable - in my opinion. Especially as the product is targeted at "the elderly".

I'm right - you're wrong. Get over it. I posted the information for general information - not as a sport for uninformed cynics to try to rip to shreds.

If you want a proper dressing down - keep arguing.

Batman

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#2095687 24-Sep-2018 17:53

Fred99:

I do hope you're not referring to me as "resident scientist". I left school at 12 (expelled). If so - how dare you. Regardless of that, I did work for a while for the largest aspirin and paracetamol manufacturer in the world at the time, the money was very good, but I still know nothing.

You mention Australia - here are the current AMA guidelines:

Aspirin and other antiplatelet agents are no longer routinely recommended for use in primary prevention of CVD, including for people with diabetes or high absolute CVD risk. Previous recommendations for people with diabetes were based on the assumption of equivalent CVD risk to those with established CVD but without diabetes.11 However, recent primary prevention trials in patients with diabetes have not shown benefit for aspirin.12,13 Harm–benefit analyses of antiplatelet drugs for primary prevention assume that risk of CVD rises with age but risk of adverse effects does not. While it is true that CVD risk is largely determined by age, the risk of adverse effects is also likely to be higher in older people.14 An ongoing clinical trial, Aspirin in Reducing Events in the Elderly (ASPREE), is being conducted in Australian general practice to examine whether the benefits of routine aspirin outweigh the harms in patients aged 70 years or older.15

Presumably, as the result of the trials I've highlighted above - which was not coincidentally the trial I posted about to start this thread - those guidelines will be amended. You seem to think I've cited something from a Sunday paper.

The tablets in question (low dose enteric coated aspirin) are freely available on the supermarket shelf in NZ, very clearly labelled with a simple therapeutic claim. For example "Cartia helps prevent blood clotting and reduces the risk of of heart attack and stroke".

Yes there may be "fine print". That's not really acceptable - in my opinion. Especially as the product is targeted at "the elderly".

I'm right - you're wrong. Get over it. I posted the information for general information - not as a sport for uninformed cynics to try to rip to shreds.

If you want a proper dressing down - keep arguing.

Ah, militant scientism now. I'ma just quote you in case you change your post.

Fred99

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#2095697 24-Sep-2018 18:04

Batman:

Ah, militant scientism now. I'ma just quote you in case you change your post.

Oh dear - take a chill pill (though possibly not an aspirin).

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