Without heart disease, daily aspirin may be too risky | Hacker News Reader

Without heart disease, daily aspirin may be too risky

reuters.com

It's strange that this article mentions the increased risk of internal bleeding but doesn't mention the reduced risk of cancer.

Here's a study which suggests that if 1,000 people aged 60 took aspirin daily for 10 years then 3 more people would die from strokes, bleeding and ulcers, but 17 fewer people would die from cancer and heart attacks. If that's true, then the benefits of daily aspirin clearly outweighs the costs.

https://scienceblog.cancerresearchuk.org/2014/08/06/aspirin-...

I can't help but wonder if the risk of bleeding may be due to poor compliance w instructions (it's important to eat before taking asprin)

Aspirin generally and strongly reduces clotting. Bleeds are certainly not solely due to poor compliance -- any minor internal bleed is likely to become much more severe to a patient taking aspirin.

Aspirin may increase rates of some cancers.

https://discover.dc.nihr.ac.uk/content/signal-000696/aspirin...

> In the ASPREE trial, older adults with no apparent cardiovascular disease who took daily aspirin saw no benefit in terms of reducing the chance of dying or having dementia or disability. Instead, it slightly increased their mortality and bleeding risk - aspirin was associated with an excess of 1.6 deaths per 1,000 people per year. Half of these deaths were due to cancer.

(Although this is at odds with other research and so we need to be careful when interpreting it).

Interesting, but you highlight the major reproducibility crisis of many scientific studies (along with others that have resulted from unfettered money and politics contaminating modern research).

https://www.youtube.com/watch?v=LfHEuWaPh9Q

maybe this brings up a general question. If the effects of aspirin are so complex and interact with so many different forms of complications and benefits, is it even sensible to make a recommendation based on individual factors?

Is maybe some other methodology preferable, like aggregating all the negatives and positives and just make a sort of statistical recommendation?

I hope I can be forgiven to not read every single study the article references... But isn't there tremendous Economic incentive to prove asprin is dangerous?

But there are lots of people who's job depends on high asprin sales.

I am concerned this phenomenon creeps over into these studies.

I'm not 100% sure what you're saying, but aspirin is probably the cheapest drug in the world. Nobody is making huge profits from aspirin.

Source?

It's one of the most common medications. At scale I imagine even small margins create profit.

I doubt it. It's a generic that anyone can manufacture and that invariably will squeeze profit margins to almost nothing. In the UK, many supermarkets sell their own brand aspirin and paracetamol for pennies, as loss leaders.

Generic Equate brand Asprin is $3.64 for a 500 count bottle at Walmart. 3/4 of a penny per Asprin. Nobody is printing consequential profit on that.

And that's the cost in what is by far the world's most expensive healthcare environment. The other comment is correct, the competitive market for generic Asprin generally makes it a very low profit product category. The only way to make a bit of money in Asprin, is eg what Bayer does, sell things like orange flavored chewables in their low-dose subset (which is then immediately undercut by generics anyway; Bayer's 300 count version is $10 at Walgreens, the generic version is $6; two to three pennies per).

Surely the incentive of this supposedly big asprin industry would be to prove asprin is safe?

I assume the commenter was talking about other drug companies, e.g. those making drugs for heart disease.

> but 17 fewer people would die from cancer and heart attacks

The other thing to consider is that if '17 people die' there are probably a far larger number of people who don't die but get treated (for cancer) and live but have to deal with the experience of being diagnosed and treated for cancer. It would be interesting to know what that number actually is.

> "If that's true, then the benefits of daily aspirin clearly outweighs the costs."

Why add aspirin though? If you want to reduce the chance of cancer, eat less junk and more vegetables, legumes, and fruits.

Compliance is easier with aspirin than with eating well.

Personal development isn't easy, but there is no pill that can replace a healthy lifestyle.

I took the plunge into a strict, healthy diet 3 years ago and it eventually became easy.

Am I missing the reason these choices are mutually exclusive?

Aspirin may be more effective if you eat badly.

I'm not saying it is.

This is a meta-analysis of 13 studies. The rate change is certainly real, but remember this wasn't a study targeting that characteristic. I also didn't read the studies mentioned, so I don't know what time frame the change appears over (is it over a patients lifetime? a year? who knows?).

Also, all of the patients were Asian, which could also have some effect, and they were all lean. As far as I'm aware, these aren't characteristics of those who usually receive recommendations for regularly taking aspirin. Meanwhile, heart disease kills nearly a quarter of Americans.

> Results The search identified 13 randomized clinical trials of low-dose aspirin use for primary prevention, enrolling 134 446 patients. Pooling the results from the random-effects model showed that low-dose aspirin, compared with control, was associated with an increased risk of any intracranial bleeding (8 trials; relative risk, 1.37; 95% CI, 1.13-1.66; 2 additional intracranial hemorrhages in 1000 people), with potentially the greatest relative risk increase for subdural or extradural hemorrhage (4 trials; relative risk, 1.53; 95% CI, 1.08-2.18) and less for intracerebral hemorrhage and subarachnoid hemorrhage. Patient baseline features associated with heightened risk of intracerebral hemorrhage with low-dose aspirin, compared with control, were Asian race/ethnicity and low body mass index.

> Conclusions and Relevance Among people without symptomatic cardiovascular disease, use of low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage, and heightened risk of intracerebral hemorrhage for those of Asian race/ethnicity or people with a low body mass index.

Thanks for the tldr!

A meta-analysis that contains only Asians (Taiwanese) with low body mass... is not relevant to me, and frankly not particularly relevant to, "U.S. doctors have long advised adults who haven’t had a heart attack or stroke but are at high risk for these events to take a daily aspirin pill", the lead in to the article.

My neighbor took a daily baby aspirin and finally got tired of it and quit (much to his wife’s chagrin since it was her doing). He had a stroke 2 or 3 days later.

The doctors say the aspirin was helping keep things at bay but I wondered if it was more like his body adjusted for the thinner blood.

Yeah. You can’t just quit doing something like that without risk. I think suddenly thickening your blood is a risk factor for stroke. But maybe some plaque or something finally detached, no one can say for sure.

That raises a question: how do you safely stop a daily low dose aspirin regimen? Are we talking about cutting tiny pills in half, then quarters, etc. over a period of a month?

In my case it was easy: spend a month in the hospital. This was after a roller skating accident that gave me a huge brain hemorrhage. The hospital doctors went over all my prescriptions and changed nearly everything.

When taking baby Aspirin and having anticipated bleeding (e.g. planned surgery or dental work), hematologist's advice was to start preparing about two weeks in advance: take pill every other day for about a week, then stop for another week.

This paper tells The American College of Chest Physicians' recommendation is stopping 7-10 days in advance, in the clinical study they measured 96 hours (4 days) for "normalizetion of platelet reactivity":

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008770/

But please speak with your own doctor(s), your medical situation may differ.

Okay, I'm not a physician, but for me as a layman there does not seem to be anything new in the study described. Yes, not taking it without indication has always been the professional recommendation. Stopping Aspirin treatment can also increase the risk of a stroke, so the treatment shouldn't be stopped without medical supervision.

I'm wondering whether there is any example of a medicament or artificial supplement that is recommended to be taken without indication. I've never heard of something like that. Vitamin supplements should be replaced by more healthy nutrition and maybe more fresh air, more sun, and doing some sport. If there is no diagnosed deficiency, then supplements have no benefits at all. Most of the "daily supplements" you can buy in a pharmacy can be replaced by occasionally drinking a glass of orange juice, eating a banana, or eating something with honey. I once went to the pharmacy when I had a cold and didn't check what they were giving to me very carefully. At home, I realized that I just bought some pills that contained traces of honey... at a price of 16 EUR!

>more sun

Pls no. Skin cancer is no joke.

Nor are these damn rickets.

What I mean is 20 minutes/day to get your Vitamin D levels right.

Sun exposure increases skin cancer risk, but skin cancer is in most cases easily treatable if caught early, and there's evidence that sun exposure reduces all cause mortality, e.g.:

http://ar.iiarjournals.org/content/38/2/1173.long

If this is a real causal link, the next important question is how much is attributable to vitamin D synthesis (which, assuming the localization of vitamin D in the skin isn't important, could theoretically be replaced by supplements), and how much is attributable to things that can't be supplemented, e.g. increased nitric oxide synthesis. See:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593895/

Vitamin D supplements keep failing to show broad benefits in trials.

Here's a popular press writeup with citations to the relevant trials: https://www.vox.com/2018/10/4/17933880/vitamin-d-health-sun-...

I live far enough from the equator, and get little enough sunlight exposure, that I believe I was deficient. After I started supplementing I noticed my fingernails growing stronger. I didn't anticipate this happening so I didn't save samples for objective measurement, but I clearly remember that my fingernails would easily buckle if I pressed the ends against each other, and now they do not. The cost and risk is very low, so I think it's worth it for the stronger fingernails (useful as prying tools).

The elephant in the room is that big confounding factors can be expected: healthy people get more sunlight; also, people who go outside more during the daytime are likely to have healthier social lives, which is big for CVD. So the question is, how much, if any, does the sunlight itself benefit health, given that we could expect a strong correlation even if the answer is "negatively"?

https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

What do you expect to get from honey that would otherwise be found in supplements? Honey contains some known antibacterial compounds, but AFAIK none are human nutrients.

Taking 50mg before going to bed, for periods, (3-6months a year, during massive crunch time project deliveries), it helps me sleep better and be less tired, also it makes my dreams extremely vivid and more complex, is there any study on this? It is a constant aspect that I can reproduce steadily...

There actually are studies showing pain killers work for mental pain and anxiety too, not just physical pain. E.g.: https://www.sciencedaily.com/releases/2013/04/130416085431.h...

So I wouldn't be surprised if it helps you sleep, especially during stressful crunch time periods.

It's more significant than that, if you dig in on "acetaminophen emotional response" you'll find a lot of coverage of it muting response both good and bad.

Anecdatally, I know someone who takes a significant amount of Tylenol on a daily basis, and that person seems a lot more emotionally 'flat' than before that started.

People should just finally understand that there is no free lunch: any substance has side effects. Even water, depending on dosage.

That would be great. At that point, we can all collectively decide that it’s a better idea to spend more on medical research.

https://futurism.com/the-byte/doctors-autonomous-surgery-rob...

For example, deaths from cancer(s) and heart disease will drop dramatically in which decade?

Pick one. It’s really just a matter of effort.

Far better idea is to remove as much cancerous bureaucratic institutions as possible. Starting from those which promote dangerous massive top-down health advices and policies, especially which add this or that pill for non-emergency "preconditions".

Reminds me of: https://www.dhmo.org/facts.html

I read a doctor complain about the balkanization of medicine into specialties. Specialists will give advice that reduces problems in their specialty and not care if it causes problems not in their specialty.

Example: Keep children out of the sun to reduce the chance of skin cancer. Result, sub clinical rickets and myopia.

Without an abnormal https://en.wikipedia.org/wiki/Transthoracic_echocardiogram diagnosis report we should not take Aspirin Otherwise https://www.everydayhealth.com/congestive-heart-failure/guid...

What about taking it with recovery periods e.g. not at the weekends, or on alternate months? What would that do to the risk/benefit?

Is it a good idea to take extra vitamin K with aspirin when taken long-term, since it opposes the blood-thinning effect?

Ugh, this is terrible news.

I have a family history of heart disease, so I've been taking a small aspirin daily as part of my doctor's recommendation. I've been trusting this to help increase my chances of avoiding a heart attack.

I'm going to keep taking it. I don't think I'll even talk to the doctor about it.

General medical advise that is true under certain conditions. Make sure starting/stopping makes sense for you.

Consult with your doctor about getting on a statin. And if you have a family history of heart disease, I'd guess you qualify for aspirin as primary prevention.

There new guidelines in the US that still recommend aspirin based on cardiovascular risk. That aspirin increases the risk of bleeding is old news. The difficulty has been in quantifying the risk/benefit. You should consult with your doctor about your specific circumstance.

I personally find the taste of aspirin to be delicious! Not steak or candy delicious, but more like tangy taco sauce delicious.

So I chew them up and swish them around my mouth and rub them up against the inside of my lips with my tongue, to get the most effective rush and quickest headache relief.

Does anybody else do that, or am I a mutant?

It's just like citric, malic or tataric acid

Yes, that was what I was getting at: delicious like limes!

> to get the most effective rush

You get a "rush" from... aspirin?

It feels like suddenly not having a headache any more! I love it!

Caution!

https://www.ncbi.nlm.nih.gov/pubmed/15354902

Tooth erosion caused by chewing aspirin.

I wonder if there's any correlation between people who take daily/regular aspirin and vascular dementia in later life.

My Grandpa swore by daily dosing but then also battled vascular and alzheimers. Is the increased risk in bleeds only whilst taking aspirin or does it persist afterwards at all?

Here's the entry at the NNT site for daily aspirin [1].

[1] http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-a...

What's the news? My friends and I have always been aware that daily ibuprofin/aspirin could cause serious blood clotting issues.

Ibuprofen, yes. Aspirin, no.

Aspirin is a blood thinner.

Ibuprofen overuse screws up your kidneys. Aspirin prevents clotting and causes bleeding

My internal medicine MD warned me away from daily low-dose aspirin a few years ago when we discussed it during my annual physical.

"Unless you have a matching diagnosis that calls for treatment it's not something you should take routinely," were his basic words.

Thee most obvious concern that a layman could wrap their head around were bleeding complications.

So I stopped.

325mg per day here. Great.

Whoa! Is this an 81mg, 325mg, or other dose? Anyone out there know?

I have two words: OH FUCK. I take 85 mg every night (and since I live in Iran, we don't have access to high quality drugs thanks to American Orange Guerilla: President Trump). Btw, the title is misleading, 0.2 percent is not too much, is it?

Drugs are artificial modifications of the body with metabolization that has not ever been evolved. They cause problems people can't really fix it seems. It is really tragic. Antibiotics are seeming more and more dangerous by the year with new research.

“Keep your dietary cholesterol to less than 200 milligrams a day.“ [1]

Cholesterol in one egg: 373 mg [google]

Maybe, instead of taking a daily pill, a change in diet will do the trick?

[1] https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.p...

High blood cholesterol can affect anyone. It’s a serious condition that increases the risk for heart disease, the number one killer of Americans—women and men. The higher your blood cholesterol level, the greater your risk.

There still isn’t any good evidence that I have seen proving eggs increase blood cholesterol. I eat plenty and get my numbers checked every 6 months. Probably quit eating bad fats and excess carbs.

There hasn't been much if any correlation shown between dietary cholesterol and blood-level cholesterol for most people. Your digestive tract has no problems breaking cholesterol down and metabolizing it, and conversely, your liver has no problem making cholesterol. This makes sense, as cholesterol is vital for the proper functioning of your brain amongst other organs, so we can't rely on getting enough of it from our diet.

Why is the NIH then saying you shouldn’t get more than 200mg per day?

The linked report is from 2005. They are no longer making this blanket recommendation.

As another commenter points out, that's about the cholesterol contained in one egg, and less than the amount of cholesterol in a typical portion of meat. It just doesn't make sense that our body would have so many issues handling something that's been so prevalent in our diet for millions of years, and that we're well-adapted to consume. We're omnivores, not herbivores, and animal products contain cholesterol. We can handle eating it.

Of course it might make sense. We’ve not been built for longevity but for high reproduction rates. Dying with 40 is not a big deal if you’ve got enough offspring.

Also: have you tried to apply your logic to smoking? Many people I know enjoy smoking. How come evolution has optimized us for that? Just because we can handle something in the short run doesn’t mean it’s good for us in the long run.

The smoking parallel isn't very illuminating. Eating food is necessary for survival; smoking tobacco isn't. And we've been eating cholesterol-containing animal products for many tens of millions of years, long before we became Homo sapiens, whereas the smoking of tobacco is a very recent phenomenon, way too recent to have any effect on evolutionary time scales.

In what way has evolution optimized for smoking? It gives us cancer and kills us. We're clearly not optimized for it.

Dietary cholesterol has little impact on blood cholesterol.

Yes, it's confusing as the names are the same.

Yes, high blood cholesterol can lead to heart disease.

But here's the thing, the body synthesizes its own cholesterol. Mainly in the liver. Dietary cholesterol doesn't have much if anything to do with this process.

Statins work by reducing the liver's production of cholesterol leading to lower blood cholesterol levels and decreasing the risk of heart disease.

Now, a change in diet can "do the trick" and lead to lower blood cholesterol levels but for different reasons than the amount of cholesterol in the food.

The big caveat to all of this is for some people who are genetic outliers and people with diabetes.

Here are a few sources you can check out:

Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? https://www.ncbi.nlm.nih.gov/pubmed/29596318

Cholesterol Overview https://www.hsph.harvard.edu/nutritionsource/what-should-you...

Cholesterol in Food https://health.clevelandclinic.org/why-you-should-no-longer-...

If you open the first study you are citing, it’s says in the original PDF:

Conflicts of Interest: M.L.F. and C.N.B. have received prior funding from the Egg Nutrition Center. The funding sponsors had no role in the interpretation of data or the writing of the manuscript.

That's true. In this case, a broader search will show you that in spite of the potential conflict, the research seems solid.

https://examine.com/nutrition/will-eating-eggs-increase-my-c...

if dietary cholesterol is not the primary culprit, which is it ? systemic imbalance in how cholesterol and lipids are transported back and forth in your body ? vascular health ?

Meaning a low cholesterol diet person could still suffer from plaque due to accumulation ? while someone with more cholesterol intake may be ok because her/his body would not accumulate plaque ?

More about blood sugar signaling than lipid content.

It has little impact on fasting cholesterol, but absolutely raises your blood cholesterol after eating it. So e.g. you eat one egg, you get a spike in blood cholesterol. Wait 8 hours, it's gone. So it would seem that if your baseline fasting blood cholesterol is "healthy", eating one meal a day that leads to a spike in blood cholesterol should not be an issue. The problem is if you eat an egg for breakfast, then bacon on toast for brunch, then a steak for lunch, then an afternoon snack and then a burger for dinner. In that scenario your body can't clear out the dietary cholesterol you've ingested and you absolutely have a persistent raise in blood cholesterol.

Of course then there's still the question of if cholesterol is a cause of, or an indication of increased danger of cardiovascular disease. This guy [1] summarises several studies and it comes out as a shrug. At least we know that statins do help people to not have a second heart attack. The science on this is progressing slowly partly because you need to run 10-year long trials on thousands of people to get good data.

[1] https://www.youtube.com/watch?v=0RKrFQ-cKZc

That's good context that I did not know. Thanks.

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