Wednesday, August 19, 2009

Harvard's new aspirin guidelines

Here are several comments from Harvard Medical School clarifying their position on aspirin:
  • Aspirin was once used mainly to relieve pain and ease fever, but now is a mainstay for heart health. But limited evidence on aspirin’s preventive effects has made it difficult for experts to give recommendations about who benefits from daily aspirin and how much to take.

  • For men, the main benefit of aspirin is preventing a heart attack. For women, it’s preventing the kind of stroke caused by a blood clot (ischemic stroke). It’s the most common kind of stroke. For both, the risks of taking aspirin are gastrointestinal bleeding and hemorrhagic stroke.

  • It makes the most sense to take aspirin if your chance of having a heart attack or stroke is greater than the odds of aspirin causing a problem. The simplest way to figure your heart disease or stroke risk is to use an online calculator, such as the Framingham or Reynolds risk scores, which give you a percentage. If yours is 13% it means that for every 1,000 people with risk factors like yours, 130 will have a heart attack or stroke over the next 10 years. Bonnie - they failed to mention that you can take a genetic test to see if you are aspirin-compatible.

Several things boost the chances of getting into trouble with aspirin:

  • Regular use of ibuprofen (Advil, generic) or another nonsteroidal anti-inflammatory drug in addition to aspirin increases the risk of gastrointestinal bleeding fourfold.
  • Men are twice as likely as women to have gastrointestinal bleeding.
  • Having had a gastrointestinal ulcer, gastrointestinal bleeding, or hemorrhagic stroke increases the chances it will recur.
  • Uncontrolled high blood pressure or use of an anticoagulant such as warfarin (Coumadin, Jantoven, generic) also increases the risk for a hemorrhagic stroke or serious bleeding.
  • Bonnie - they fail to mention that if you are salicylate-sensitive, aspirin is poison.
Do you need aspirin for prevention?
  • Trials evaluating the heart benefits of aspirin have tested doses ranging from 500 milligrams (mg) a day to 100 mg every other day. Experts conclude that a dose of 81 mg a day, the amount in a baby aspirin, seems to work just as well as higher doses, with fewer bleeding problems.
Beyond Aspirin
  • Aspirin isn’t a miracle worker. It lowers the chances of having a first heart attack or stroke, which is great, but it means you can’t rely on aspirin alone to protect you. If you’re really serious, there’s a lot more you can do. The combination of not smoking, maintaining a healthy weight, exercising daily, choosing a healthful diet, and drinking alcohol in moderation lowers the risk of having a heart attack or stroke between 50% and 80%.
Bonnie - based upon the newest research, Harvard's position may even be too encouraging (see routine benefits of Aspirin questioned).

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