
Without heart disease, daily aspirin may be too risky - wjSgoWPm5bWAhXB
https://www.reuters.com/article/us-health-heart-aspirin/without-heart-disease-daily-aspirin-may-be-too-risky-idUSKCN1SJ275
======
MarkMc
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-...](https://scienceblog.cancerresearchuk.org/2014/08/06/aspirin-
and-cancer-not-quite-but-nearly/)

~~~
DanBC
Aspirin may increase rates of some cancers.

[https://discover.dc.nihr.ac.uk/content/signal-000696/aspirin...](https://discover.dc.nihr.ac.uk/content/signal-000696/aspirin-
did-not-prevent-deaths-or-disability-in-healthy-older-adults)

> 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).

~~~
Barrin92
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?

------
ashelmire
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.

~~~
kurthr
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.

------
leetrout
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.

~~~
pmiller2
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?

~~~
bd
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/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008770/)

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

------
JohnStrangeII
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!

~~~
layoutIfNeeded
>more sun

Pls no. Skin cancer is no joke.

~~~
mrob
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](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/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593895/)

~~~
khuey
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-...](https://www.vox.com/2018/10/4/17933880/vitamin-d-health-sun-diet)

~~~
mrob
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).

------
siliconunit
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...

~~~
lnanek2
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...](https://www.sciencedaily.com/releases/2013/04/130416085431.htm)

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

~~~
fencepost
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.

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

~~~
melling
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...](https://futurism.com/the-byte/doctors-autonomous-surgery-robot-heart)

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

    
    
       [ ] 2120
       [ ] 2070
       [ ] 2050
       [ ] 2030
    

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

~~~
juskrey
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".

------
known
Without an __abnormal
__[https://en.wikipedia.org/wiki/Transthoracic_echocardiogram](https://en.wikipedia.org/wiki/Transthoracic_echocardiogram)
diagnosis report we should not take Aspirin Otherwise
[https://www.everydayhealth.com/congestive-heart-
failure/guid...](https://www.everydayhealth.com/congestive-heart-
failure/guide/treatment/)

------
winchling
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?

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

------
RickJWagner
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.

~~~
tellak
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.

------
DonHopkins
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?

~~~
homero
It's just like citric, malic or tataric acid

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

------
BuildTheRobots
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?

------
tzs
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...](http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-attack-
or-stroke-2/)

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

~~~
Spooky23
Ibuprofen overuse screws up your kidneys. Aspirin prevents clotting and causes
bleeding

------
AceyMan
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.

------
eyeball
325mg per day here. Great.

------
aj7
Whoa! Is this an 81mg, 325mg, or other dose? Anyone out there know?

------
rodmena
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?

------
Madmallard
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.

------
baxtr
_“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...](https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf)

 _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._

~~~
heymijo
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](https://www.ncbi.nlm.nih.gov/pubmed/29596318)

Cholesterol Overview [https://www.hsph.harvard.edu/nutritionsource/what-
should-you...](https://www.hsph.harvard.edu/nutritionsource/what-should-you-
eat/fats-and-cholesterol/cholesterol/)

Cholesterol in Food [https://health.clevelandclinic.org/why-you-should-no-
longer-...](https://health.clevelandclinic.org/why-you-should-no-longer-worry-
about-cholesterol-in-food/)

~~~
baxtr
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._

~~~
theNewMicrosoft
[https://examine.com/nutrition/will-eating-eggs-increase-
my-c...](https://examine.com/nutrition/will-eating-eggs-increase-my-
cholesterol/)

