Aspirin About-Face

The new recommendation is that aspirin should not be used to prevent heart attack in those without a history of heart disease (ie avoid routine aspirin for "primary prevention"). Aspirin for primary prevention has always been a grey area. The reversal came after a large trial in the New England Journal of Medicine looking at this. The trial showed the decrease in cardiovascular events was balanced by a similar increase of bleeds. So it's still grey because some people would prefer to bleed because blood is easily replaceable, your heart is not.

What remains clear is that people who have had heart attacks, strokes, or peripheral arterial disease should in most cases continue their anti-platelet agent.

On a slightly related note, it seems many people don't know (aren't being told) the risks associated with not taking a drug and taking it. It seems like is just "the FDA ruled the benefits out weight the risks" and that gets applied to everyone. Just like generally safe is often misinterpreted as completely safe.

"The U.S. task force wants to strongly discourage anyone 60 and older from starting a low-dose aspirin regimen, citing concerns about the age-related heightened risk for life-threatening bleeding."

I understand that the bleeding is a serious concern, but does that have an immediate, potentially fatal or life changing impact - or does it happen with enough warning that you could stop taking aspirin and/or get medical assistance?

If so, then I think most people would feel that is worth the risk to take aspirin even though it has a more numerically higher likelihood of a bad outcome.

As an example, in one study, for elderly patients the NNT of a number of (admittedly different) sedative hypnotics was 13, while the NNH was 6 [1]. From that alone, you'd probably rightfully avoid using them! But for certain populations who have chronic insomnia, the benefits may still outweigh the risks.

Of course, there are ways to (less subjectively albeit still subjectively) quantify harm, and these get used to keep "harm" comparable to "treatment". But it can definitely be more of an art than an exact science.

[1] https://www.ncbi.nlm.nih.gov/books/NBK71441/

> You read that a new drug reduces your chance of dying from Ryantastic syndrome by 40 percent. Here’s what that means in practice: if 10 in 100,000 people normally die from Ryantastic syndrome, and everyone takes the new drug, only 6 in 100,000 people will die from Ryantastic syndrome. Now let’s think about it from an NNT perspective.

> For 100,000 patients who took the new drug, four deaths by Ryantastic syndrome were avoided, or one per 25,000 patients who took the drug. So the NNT is 25,000; that is, 25,000 patients must take the drug in order for one death-by-Ryantastic to be avoided. Ideally, you also want to know the NNH, or “number needed to harm.”

> Let’s say that 1 in 1,000 patients who take the new drug suffer a particular grievous side effect. In that case, the NNH is 1,000, while the NNT is 25,000. Suddenly, the decision seems a lot more complicated than if you’re just told the drug will lower your chance of dying from Ryantastic syndrome by 40 percent.

1) that there was this significant bleeding from baby aspirin

2) that a miracle drug from 300bc is being found to have downsides.

I'm still an aspirin proponent for treating sunburns and minor ailments. And salycilic acid for my face routine.

Fish oil's recent science on hormone regulation and inflammation reduction should make it a first stop.

Then there is AKG.