Monday October 21, 2019

Taking Daily Aspirin Pill Without Heart Disease Increases the Risk of Brain Bleeding

For the current study, researchers examined data from 13 clinical trials testing the effects of aspirin against a placebo or no treatment in more than 134,000 adults

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aspirin, heart disease
Aspirin pills are arranged on a counter in New York, Aug. 23, 2018. New studies find most people won't benefit from taking daily low-dose aspirin to prevent a first heart attack or stroke. VOA

For people without heart disease, taking a daily aspirin to prevent heart attacks and strokes may increase the risk of severe brain bleeding to the point where it outweighs any potential benefit, a research review suggests.

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, an approach known as primary prevention. Even though there’s clear evidence aspirin works for this purpose, many physicians and patients have been reluctant to follow the recommendations because of the risk of rare but potentially lethal internal bleeding.

For the current study, researchers examined data from 13 clinical trials testing the effects of aspirin against a placebo or no treatment in more than 134,000 adults. The risk of intracranial hemorrhage, or brain bleeds, was rare: taking aspirin was associated with two additional cases of this type of internal bleeding for every 1,000 people, the study found.

But the bleeding risk was still 37 percent higher for people taking aspirin than for people who didn’t take this drug. “Intracranial hemorrhage is a special concern because it is strongly associated with a high risk of death and poorer health over a lifetime,” said study co-author Dr. Meng Lee of Chang Gung University College of Medicine in Taiwan.

heart disease, aspirin
“We have long known that aspirin can precipitate bleeding, most commonly in the gastrointestinal tract, but most devastatingly in the brain,” said Dr. Samuel Wann. Pixabay

“These findings suggest caution regarding using low-dose in individuals without symptomatic cardiovascular disease,” Lee said by email.

Post-cardiac event use

For people who have already had a heart attack or stroke, the benefit of low-dose aspirin to prevent another major cardiac event is well established, researchers note in JAMA Neurology. But the value of aspirin is less clear for healthier people, for whom bleeding risks may outweigh any benefit, the study team writes.

Already, guidelines on aspirin for primary prevention of heart disease in the U.S., Europe and Australia have incorporated a need to balance the potential benefits against the risk of bleeding. For elderly people, who have a greater risk of bleeding than younger adults, the risks may be too great to recommend aspirin.

For adults ages 50 to 59 considering aspirin to prevent heart attacks and strokes, for example, the U.S Preventive Services Task Force (USPSTF) recommends the pill only for people who have at least a 10 percent risk of having a heart attack or stroke over the next decade and who don’t have a higher-than-average risk of bleeding. (The American College of Cardiology provides an online risk calculator.

Heart disease, aspirin
For people without heart disease, taking a daily aspirin to prevent heart attacks and strokes may increase the risk of severe brain bleeding. Pixabay

One limitation

One limitation of the analysis is that the smaller clinical trials examined a variety of aspirin doses up to 100 milligrams daily. The analysis also only focused on brain bleeds, and not on other types of internal bleeding associated with aspirin.

“We have long known that aspirin can precipitate bleeding, most commonly in the gastrointestinal tract, but most devastatingly in the brain,” said Dr. Samuel Wann, a cardiologist at Ascension Healthcare in Milwaukee, Wisconsin, who wasn’t involved in the study.

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Despite the benefits for preventing heart attacks, the consensus on aspirin has changed over time, particularly for people without heart disease or hardening and narrowing of thearteries (atherosclerosis).

“We have previously recommended aspirin to prevent platelets from sticking to the inside of an individual’s arteries, but the benefit, while real, turns out to be small compared to the rare but devastating incidence of brain hemorrhage,” Wann said by email. “We no longer recommend routine use of aspirin in individuals who have no demonstrable cardiovascular disease or atherosclerosis.” (VOA)

Next Story

Eating Red Meat Links to Cancer and Heart Disease, but are the Risks Big Enough to Give Up Burgers and Steak?

In a series of papers published Monday, the researchers say the increased risks are small

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Red Meat, Cancer, Heart Disease
FILE - A beef steak is cut at the Taberna del Gijon restaurant in Madrid, Spain, July 26, 2017. VOA

Eating red meat is linked to cancer and heart disease, but are the risks big enough to give up burgers and steak?

A team of international researchers says probably not, contradicting established advice. In a series of papers published Monday, the researchers say the increased risks are small and uncertain and that cutting back likely wouldn’t be worth it for people who enjoy meat.

Their conclusions were swiftly attacked by a group of prominent U.S. scientists who took the unusual step of trying to stop publication until their criticisms were addressed.

The new work does not say red meat and processed meats like hot dogs and bacon are healthy or that people should eat more of them. The reviews of past studies generally support the ties to cancer, heart disease and other bad health outcomes. But the authors say the evidence is weak, and that there’s not much certainty meat is really the culprit, since other diet and lifestyle factors could be at play.

Red Meat, Cancer, Heart Disease
FILE – Packed U.S. beef is displayed at a supermarket in Chiba, east of Tokyo, Japan, Aug. 9, 2006. VOA

Most people who understand the magnitude of the risks would say “Thanks very much, but I’m going to keep eating my meat,” said co-author Dr. Gordon Guyatt of McMaster University in Canada.

It’s the latest example of how divisive nutrition research has become, with its uncertainties leaving the door open for conflicting advice. Critics say findings often aren’t backed by strong evidence. Defenders counter that nutrition studies can rarely be conclusive because of the difficulty of measuring the effects of any single food, but that methods have improved.

“What we need to do is look at the weight of evidence — that’s what courts of law use,” said Dr. Walter Willett, a professor of nutrition at Harvard University who was among those calling for the papers’ publication to be postponed.

Willett, who has led studies tying meat to bad health outcomes, also said the reviews do not consider the particularly pronounced benefits of switching from red meat to vegetarian options.

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The journal, Annals of Internal Medicine, defended the work and said the request to have it pulled before publication is not how scientific discourse is supposed to happen. Guyatt called the attempt to halt publication “silly.”

In the papers, the authors sought to gauge the potential impact of eating less meat, noting the average of two to four servings a week eaten in North America and Western Europe. They said the evidence for cutting back wasn’t compelling. For example, they found that cutting three servings a week would result in seven fewer cancer deaths per 1,000 people.

Based on the analyses, a panel of the international researchers said people do not have to cut back for health reasons. But they note their own advice is weak and that they didn’t take into account other factors, such as animal welfare and the toll meat production has on the environment.

There was dissent even among the authors; three of the 14 panelist said they support reducing red and processed meats. A co-author of one review is also among those who called for a publication delay.

Red Meat, Cancer, Heart Disease
A team of international researchers says probably not, contradicting established advice. Pixabay

Those who pushed to postpone publication also questioned why certain studies were included or excluded in the reviews. Harvard’s Dr. Frank Hu also noted that about a third of American adults eat at least one serving of red meat a day. He said the benefits of cutting back would be larger for those who eat such high amounts.

Still, other researchers not involved in the reviews have criticized nutrition science for producing weak and conflicting findings. Dr. John Ioannidis, a professor of medicine at Stanford University, said such advice can distract from clearer, more effective messages, such as limiting how much we eat.

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As for his own diet, Guyatt said he no longer thinks red or processed meats have significant health risks. But he said he still avoids them out of habit, and for animal welfare and environmental reasons. (VOA)