Tag Archives: aspirin

Aspirin use may increase the risk of heart failure among at-risk individuals

Aspirin may increase the risk of heart failure in individuals with at least one underlying health factor that predisposes them to such conditions, a new study finds.

Image credits Miguel Á. Padriñán.

Aspirin is a commonly-used drug prescribed, among other uses, as a blood-thinning agent. Blood thinners are anticoagulants, substances that prevent blood from clotting, or that slow down its clotting speed. They’re prescribed to individuals at risk of heart attacks and strokes in order to reduce the chances of such events taking place, as they are caused by blood clotting inside our arteries and veins (where it shouldn’t).

However, this study calls into question the wisdom of prescribing aspirin for such purposes. According to the findings, aspirin may actually increase the risk of heart failure for patients with at least one predisposing factor.

Lesspirin

“This is the first study to report that among individuals with at least one risk factor for heart failure, those taking aspirin were more likely to subsequently develop the condition than those not using the medication,” said study author Dr. Blerim Mujaj of the University of Freiburg, Germany.

“While the findings require confirmation, they do indicate that the potential link between aspirin and heart failure needs to be clarified.”

Despite its use as a preventive treatment for heart failure, aspirin’s effects on this condition remain controversial. The team wanted to provide a better look at the interaction between the two, both in patients with and without heart disease, and whether its use can promote the emergence of heart disease in patients who are already at risk of developing it.

According to the findings, aspirin use is associated with a 26% higher risk of heart failure in patients with at least one predisposing factor. These include smoking, obesity, high blood pressure, high cholesterol, diabetes, and cardiovascular disease.

The study worked with 30,827 participants enrolled from Western Europe and the US into the HOMAGE (Heart OMics in AGEing) study; all were flagged as being ‘at risk’ for developing heart failure due to one of the factors listed above. All participants were aged 40 and above (average age 67) and had not experienced any incidents of heart failure at the start of the study. Roughly 34% of the participants were women.

Their aspirin use was recorded at the start of the study, based on which they were classified as ‘users’ or ‘non-users’. Follow-up investigations were performed at the first fatal or non-fatal heart failure event that required the participant’s hospitalisation.

At baseline, a total of 7,698 participants (25%) were taking aspirin. Over the 5.3-year duration of the study, 1,330 developed heart failure.

The 26% increased risk figure was obtained after adjusting for a whole host of factors including but not limited to sex, age, body mass index, smoking, alcohol use, blood pressure, and hypertension. This means that the increase in risk observed in the study comes down to the use of aspirin exclusively.

In order to verify the results, the team repeated the analysis after matching users and non-users based on risk factors. In this step, aspirin was associated with a 26% increased risk of a new heart failure diagnosis. The authors then excluded patients with a history of cardiovascular disease from the data pool and performed the analysis yet again. Among the 22,690 participants (74% of the initial number) free of cardiovascular disease, aspirin use was associated with a 27% increased risk of developing heart failure.

“This was the first large study to investigate the relationship between aspirin use and incident heart failure in individuals with and without heart disease and at least one risk factor,” Dr. Mujaj explains. “Aspirin is commonly used — in our study one in four participants were taking the medication. In this population, aspirin use was associated with incident heart failure, independent of other risk factors.”

“Large multinational randomised trials in adults at risk for heart failure are needed to verify these results. Until then, our observations suggest that aspirin should be prescribed with caution in those with heart failure or with risk factors for the condition.”

The paper “Aspirin use is associated with increased risk for incident heart failure: a patient‐level pooled analysis” has been published in the journal ESC Heart Failure.

Aspirin could become a potential treatment against breast cancer

Credit: Pixabay.

Aspirin (acetylsalicylic acid), the world’s most popular drug, may one day become an important component in treatments against some of the most aggressive forms of breast cancer. Clinical trials have commenced in the United Kingdom in order to establish whether aspirin can enhance immunotherapy for patients with triple-negative breast cancer.

Could aspirin become a generic cancer drug? Some scientists want to find out

Aspirin is classed as a non-steroidal anti-inflammatory drug that is primarily recommended to reduce pain and inflammation. Until not long ago, doctors used to recommend it to prevent heart attacks and strokes, but recent research suggests healthy people with no history of cardiovascular disease shouldn’t routinely use aspirin due to internal bleeding risks.

But, more strikingly, some studies seem to indicate that this cheap and widely available generic drug could also play an important role in battling cancer. A 2014 study led by Professor Jack Cuzick, head of the center for cancer prevention at Queen Mary University of London, found that people who took aspirin daily for at least five years had a 35% reduction in bowel cancer, as well as a 30% reduction in esophageal and stomach cancers.

“Aspirin is showing promise in preventing certain types of cancer, but it’s vital that we balance this with the complications it can cause – such as bleeding, stomach ulcers, or even strokes in some people,” said Dr. Julie Sharp, head of health information at Cancer Research UK.

Emboldened by previous research that hints at aspirin’s potential role in treating cancer, a team of scientists, led by Dr. Anne Armstrong from the Christie NHS foundation trust in Manchester, UK, have embarked on a new clinical trial that will see aspirin combined with avelumab, a fully human monoclonal antibody medication for cancer.

During the trial, patients with triple-negative breast cancer will be given avelumab either with or without aspirin before receiving surgery and chemotherapy.

Triple-negative breast cancer is considered to be more aggressive and has a poorer prognosis than other types of breast cancer. It is characterized by the lack of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), hence its name. Around 15% of breast cancers are of this type.

 “Our earlier research has suggested that aspirin can make certain types of immunotherapy more effective by preventing the cancer from making substances that weaken the immune response,” Armstrong told The Guardian.

“Anti-inflammatory drugs like aspirin could hold the key to increasing the effectiveness of immunotherapy when used at the same time. Trialing the use of a drug like aspirin is exciting because it is so widely available and inexpensive to produce. ”

“We hope our trial will show that, when combined with immunotherapy, aspirin can enhance its effects and may ultimately provide a safe new way to treat breast cancer.”

Can aspirin reduce the risk of death in hospitalized COVID-19 patients?

Researchers at the University of Maryland School of Medicine showed COVID-19 patients who were taking a daily low-dose aspirin for cardiovascular disease had a significantly lower risk of complications and death compared to those who were not taking aspirin.

The researchers looked through the medical records of 412 COVID-19 patients, age 55 on average, who were hospitalized over the past few months due to complications of SARS-CoV-2 infection. About a quarter of the patients were taking a daily low-dose aspirin (usually 81 milligrams) before they were admitted or right after admission to manage their cardiovascular disease.

The researchers found aspirin use was associated with a 44 percent reduction in the risk of being put on a mechanical ventilator, a 43 percent decrease in the risk of ICU admission, and — most important of all — a 47 percent decrease in the risk of dying in the hospital compared to those who were not taking aspirin. The patients in the aspirin group did not experience a significant increase in adverse events such as major bleeding while hospitalized. The study definitely showed an association or correlation but remember correlation does not mean causation.

Nevertheless, this is promising because if this finding is confirmed (through clinical trials with larger sample size), it would make aspirin the first widely available, over-the-counter medication to reduce mortality in COVID-19 patients. Aspirin is a very potent antiplatelet agent. As soon as aspirin interacts with a platelet, that platelet becomes inactivated and can no longer create clots.

British Heart Foundation | How does aspirin work?

In July a study published in the Journal of the American College of Cardiology reviewed the effect of anticoagulant drugs on outcomes among hospitalized Covid-19 patients. Like the recent aspirin study, the investigators found that anticoagulants significantly reduced the risk of death among certain groups of people with Covid-19. Although these studies are encouraging, we need to wait for further studies to be done. Aspirin came into being in the late 1890s in the form of acetylsalicylic acid when chemist Felix Hoffmann at Bayer in Germany used it for his father’s rheumatism but salicin, which comes from the bark of the willow plant has been widely used hundreds of years before that.

Now, aspirin Is not only used to reduce pain, fever, or inflammation but is also the cornerstone of therapy to prevent a heart attack or a stroke since 1970s but the drug is not without risks. The greatest risk associated with aspirin is gastrointestinal bleeding so people who have a history of peptic ulcers or bleeding from the stomach should not take it.

The good news is the United Kingdom’s Recovery Trial, a large randomized controlled clinical study of potential COVID-19 treatments, will investigate aspirin as a possible therapy. Why aspirin? Patients with COVID-19 are at higher risk of blood clots forming in their blood vessels. Platelets, small cell fragments in the blood that stop bleeding, seem to be hyperreactive in COVID-19 and may be involved in the clotting complications.

Aspirin is already widely used to prevent blood clots in many other conditions but enrolling patients in a randomized clinical trial is the best way to assess whether there are clear benefits for patients with COVID-19 and whether those benefits outweigh any potential side-effects such as the risk of bleeding. At least 2,000 patients are expected to get 150mg of aspirin daily along with the usual regimen. Hopefully, in a few months, we’ll know whether aspirin is indeed good for patients with COVID-19.

The Recovery trial was the first to show that dexamethasone, a steroid that is also cheap and widely available, could save the lives of people severely ill with Covid-19. It also showed that the anti-malarial drug hydroxychloroquine provided no benefit in treating COVID-19 patients.

Credit: Flickr.

Daily aspirin use puts millions of people at risk who do not have a history of heart disease

Credit: Flickr.

Credit: Flickr.

Until not too long ago, doctors used to recommend the routine use of aspirin to prevent heart attack and stroke. This all changed after a number of major clinical trials found few benefits to this kind of practice. Meanwhile, daily aspirin use is associated with internal bleeding risks. In response to this new science, the American Heart Association and American College of Cardiology now recommends against the daily use of aspirin for people older than 70 or those with bleeding risk who don’t have any existing cardiovascular disease.

The benefit of taking aspirin for the majority of otherwise healthy adults just doesn’t outweigh the risks enough

Millions of people routinely use aspirin when they shouldn’t, according to a new study conducted by researchers at the Beth Israel Deaconess Medical Center (BIDMC).

“Although prior American Heart Association and American College of Cardiology guidelines recommended aspirin only in persons without elevated bleeding risk, the 2019 guidelines now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke,” said senior author Christina C. Wee, a general internist and researcher at BIDMC and Associate Professor of Medicine at Harvard Medical School.

“Our findings suggest that a substantial portion of adults may be taking aspirin without their physician’s advice and potentially without their knowledge,” she said.

For decades, aspirin — which costs pennies and doesn’t require a prescription — was considered an easy way to prevent a heart attack, stroke or other cardiovascular events for all people. But this assumption has been challenged by a string of new studies.

The new guidelines apply to people who don’t have known heart disease or stroke problems but who might consider taking aspirin to prevent heart attack or stroke in the first place. These recommendations do not apply to people who already have had a stroke or heart attack, or who have undergone bypass surgery.

“It’s sort of back to the Hippocratic oath. Our job is first, do no harm. That’s what has contributed to an evolution in how we think about aspirin in primary prevention,” said Dr. Daniel Muñoz, an assistant professor of cardiovascular medicine at Vanderbilt University Medical Center in Tennessee, and one of the members of the guideline writing committee.

In a new study, researchers analyzed data from the 2017 National Health Interview Survey (NHIS), a nationally representative survey of American households which was conducted before the release of the new guidelines. Strikingly, the analysis revealed that about a quarter of adults aged 40 years or older without cardiovascular disease took daily aspirin to prevent any heart disease in the future. That’s equivalent to 29 million people, of which 6.6 million did so without seeking a physician’s opinion.

What’s more, nearly half of adults 70 years of age or older without a history of heart disease or stroke reported taking aspirin daily.

“Our findings show a tremendous need for health care practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease,” said lead author Colin O’Brien, a senior internal medicine resident at BIDMC and fellow at Harvard Medical School.

“These findings are applicable to adults who do not have a history of cardiovascular disease or stroke. If you are currently taking aspirin, discuss it with your doctor to see if it is still needed for you,” said Stephen Juraschek, MD, PhD, a primary care physician at BIDMC.

The findings were reported in the Annals of Internal Medicine.

More evidence that aspirin and ibuprofen don’t help with back pain

Scientists have shown that despite popular belief, aspirin and ibuprofen (also known as acetaminophen or paracetamol) don’t help with back pain at all.

Image credits: Derrick Coetzee

Over-the-counter pills are quite popular, but do they really help? Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are taken for many reasons, from common colds to hangovers or muscle aches. But they don’t always help, despite what many people think. A new study has found that in the case of back pain at least, they do little more than a placebo.

It’s not that they don’t do anything… it’s just that they don’t do anything for most people. The doctors report that for every patient reporting a clinically significant decrease in pain after two weeks on an NSAID, another six didn’t. This builds on previous studies, including a Cochrane review conducted in 2015 which found that ibuprofen is little more than a placebo for acute back pain.

Researchers from the George Institute for Global Health in Australia analyzed data from 35 peer-reviewed studies which included 6,065 patients with spinal pain. They found that despite being the most taken pills for back pain, paracetamol and its variants do basically nothing to ease the pain.

“When this result is taken together with those from recent reviews on paracetamol and opioids, it is now clear that the three most widely used, and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo,” they write in their paper.

Even stronger drugs, opiates such as codeine or OxyContin provide only modest short-term relief for those with chronic back pain, according to research published inJAMA Internal Medicine in 2016.

While this might seem like pretty grim news, it’s actually good news. For most people, back pain is a temporary, passing issue, but the people who struggle with chronic issues deserve better treatment.

Team researcher Manuela Ferreira advises in The Guardian:

“We are not arguing that no pain relief should be used, but people using these types should be aware the benefits are small and that their side effects can be harmful, and that discussing with their doctors the benefit of other treatments including exercise may be worthwhile.”

Also, it’s quite shocking to see that such a common problem was mistreated by so many people for so many years.

Journal Reference: Gustavo C Machado, Chris G Maher, Paulo H Ferreira, Richard O Da — Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis doi:10.1136/annrheumdis-2016-210597

An aspirin a day could dramatically reduce cancer risk, huge study concludes

The new study concludes that an aspirin a day for middle-aged people could save 130,000 lives over 20 years in Britain alone, by reducing cancer risk.

Aspirin was most effective in cutting cancer risk in people from 50 to 64, and in order for the effects to be felt to the fullest, people should take 1 aspirin per day for 10 years – after that, even if they stop, the positive effects are still felt. The research team led by Professor Jack Cuzick, head of the centre for cancer prevention at Queen Mary University of London believes that aspirin is one of the best things you could do to cut down cancer risk:

“[Aspirin] looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity, and will probably be much easier to implement”.

He also backs this up with his personal example, explaining that he has routinely taken aspirin for the past years.

“I take aspirin as part of a bedtime ritual every day and I can achieve that quite easily,” he said.

However, before effects could be significantly felt, you’d have to take it constantly for at least 5 years, and preferably up to 10. If you do that, they explain in the study, the risk of bowel cancer cases could be cut by about 35% and deaths by 40%. Aspirin could reduce rates of oesophageal and stomach cancers by 30% and deaths from them by 35% to 50%. However, there’s also a downside to taking aspirin.

While taking it does reduce the risk of cancer, it also increases the risk of stomach bleeds among 60-year-olds from 2.2% to 3.6%. In about 5% of those who have a stomach bleed, it could be fatal. It also reduces the risk of some strokes, and increases the risk of other ones. Especially for people who have the bacterium Helicobacter pylori in their stomach should be careful, as they are subject to most stomach related risks. Before you embark on an aspirin-rich diet, you should consult with your doctor, and perhaps conduct some tests on your stomach and blood circulation, to see if you’re not doing yourself more harm than good.

“Aspirin is showing promise in preventing certain types of cancer, but it’s vital that we balance this with the complications it can cause – such as bleeding, stomach ulcers, or even strokes in some people,” said Dr Julie Sharp, head of health information at CRUK.

“Before aspirin can be recommended for cancer prevention some important questions need to be answered, including what is the best dose and how long people should take it for. And tests need to be developed to predict who is likely to have side-effects.

“Given the continued uncertainty over who should take aspirin, Cancer Research UK is funding a number of trials and research projects to make the picture clearer,” she concludes.

Something important to note is that the patent for aspirin as a generic drug ran out in the 1930s. It was developed by Bayer, but now, countless companies make it. There is an estimate 100 bn tablets taken around the world every year, and no pharmaceutical company makes huge profits from it, so this is not one of those for-profit studies. However, the lead researchers are all working or have worked at one point with Bayer. Another interesting trivia fact is that when Bayer released aspirin, it also rolled out another drug, one which was not as successful, but still carries on to this day: heroin.

Scientific Reference: J. Cuzick1, M. A. Thorat1, C. Bosetti, P. H. Brown, J. Burn, N. R. Cook, L. G. Ford, E. J. Jacobs, J. A. Jankowski, C. La Vecchia, M. Law, F. Meyskens, P. M. Rothwell13, H. J. Senn and A. Umar. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol (2014)
doi: 10.1093/annonc/mdu225