Thursday, October 2, 2008

Jon's Health Tips: Aspirin

I take aspirin regularly. So does my internist. Here’s why:
Aspirin, long known to relieve fevers, aches and pain, has served an increasingly bigger role in health care in recent years. A daily aspirin may help lower the risk of heart attack and clot-related strokes. An estimated 20 million men and women take a low dose of aspirin (81-325 mg daily) to control heart disease.
The November issue of Mayo Clinic Women’s HealthSource discusses why millions of Americans opt to take a daily low-dose aspirin and how this therapy seems to work a bit differently for women and men.
Aspirin reduces the clumping action of platelets, the blood’s clotting cells. Clotting helps a cut or wound stop bleeding. But clots also form within blood vessels that supply the heart and brain. If the vessels are already narrowed from a buildup of fatty deposits, a blood clot can quickly block an artery, causing a heart attack or stroke.
Early studies on aspirin therapy only involved men. New studies confirm that women may benefit from aspirin therapy, too, but not exactly the way men benefit. Recent studies identified these differences and similarities between the sexes and showed that aspirin:
n Helps prevent a first stroke for women. There’s no risk reduction for men.
n Helps prevent a first heart attack for women over age 65 and for all men.
n Helps prevent a second heart attack for men and women, regardless of age.
Women who take low to moderate doses of aspirin have a reduced risk of death from any cause, and especially heart disease–related deaths, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Women who reported using aspirin currently had a 25 percent lower risk of death from any cause than women who never used aspirin regularly. The association was stronger for death from cardiovascular disease (women who used aspirin had a 38 percent lower risk) than for death from cancer (women who used aspirin had a 12 percent lower risk).
People with prehypertension who are treated with aspirin may experience significant reductions in blood pressure—but only if they take the pill before bedtime, and not when they wake up in the morning.
People with prehypertension (a blood pressure reading between normal and high; when systolic blood pressure is between 120 and 139 or diastolic blood pressure is between 80 and 89 on multiple readings) are at significant risk of hypertension, or consistently high blood pressure—the biggest risk factor for heart disease and stroke, the two leading causes of death in the Western world.
Different types of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and aspirin, appear to be equally effective in lowering the risk of Alzheimer’s disease, according to the largest study of its kind published in the May 28, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology. Experts have debated whether a certain group of NSAIDs that includes ibuprofen may be more beneficial than another group that includes naproxen and aspirin.
Using information from six different studies, researchers examined data on NSAID use in 13,499 people without dementia. Over the course of these six studies, 820 participants developed Alzheimer’s disease.
Researchers found that people who used NSAIDs had 23 percent lower risk of developing Alzheimer’s disease compared to those who never used NSAIDs. The risk reduction did not appear to depend upon the type of NSAID taken.
Common painkillers like aspirin and ibuprofen appear to lower a man's PSA level, the blood biomarker widely used by physicians to help gauge whether a man is at risk of prostate cancer.
But the authors of the study, which appears online Sept. 8 in the journal Cancer, caution that men shouldn't take the painkillers in an effort to prevent prostate cancer just yet.
"We showed that men who regularly took certain medications like aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDS, had a lower serum PSA level," said first author Eric A. Singer, M.D., M.A., a urology resident at the University of Rochester Medical Center. "But there's not enough data to say that men who took the medications were less likely to get prostate cancer.
American Heart Association Scientific Statement: Many doctors should change the way they prescribe pain relievers for chronic pain in patients with or at risk for heart disease based on accumulated evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, increase risk for heart attack and stroke, according to an American Heart Association statement published today in Circulation: Journal of the American Heart Association.
People should talk with their doctor before starting an aspirin a day. Regular aspirin use increases the risk of stomach ulcers or a bleeding (hemorrhagic) stroke. Current medical literature suggests that women who are at high risk of heart disease should be on daily aspirin therapy. However, people should weigh the benefits and risks with their doctor.

Aspirin can reduce colorectal cancer risk
Safer drugs needed before regular preventive therapy can be recommended
A study of Medicare patients with osteoarthritis provides additional evidence that non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin reduce the risk of colorectal cancer.

Researchers found that men who used aspirin regularly experienced a significantly lower risk of colorectal cancer, including distal colon cancer, proximal colon cancer and rectal cancer, even after controlling for other risk factors. The reduction in risk was seen in both early (stage I/II) and advanced (stage III/IV) colorectal cancers.

"The compelling evidence that chronic use of aspirin or certain NSAIDS can substantially lower the risk of colon cancer has important implications, especially because colon cancer is the second leading cause of cancer death," writes Dr. Markowitz, the Francis Wragg Ingalls Professor of Cancer Genetics at UHCMC and Case Western Reserve University School of Medicine.

Harvard researchers' findings demonstrated that two-thirds of colon cancers have high levels of expression of the COX-2 enzyme, which is blocked by aspirin. Individuals who regularly used aspirin over a course of several years demonstrated a 36% decrease in the risk of developing one of these high COX-2 expressing colon cancers. These results again demonstrated that drugs that block COX-2 can decrease the risk of colon cancer, and demonstrated that such drugs specifically target those individuals whose tumor development is encouraged by the action of the COX-2 enzyme.

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