In a previous blog, “Taking low-dose aspirin and NSAIDs can be a challenge – (Part 1),” I wrote:
- I have many patients who are taking low-dose (81 mg) aspirin (ASA) daily and who wonder if they can take a Non-Steroidal Ant-Iinflammatory Drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) for pain or fever. I warn them that adding an NSAID increases their gastrointestinal (GI) risk … and can possibly increase their cardiovascular (CV) risk. Continue reading
I have many patients who are taking low-dose (81 mg) aspirin (ASA) daily and who wonder if they can take a Non-Steroidal Ant-Iinflammatory Drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) for pain or fever. Continue reading
In the advertisements for aspirin you see every day on TV and in magazines, they have for years called it a wonder drug. Now, more and more of us doctors are finding that is truly the case. In past blogs I’ve told you, “Low-dose aspirin reduces risk of developing and dying from colon cancer,” and “Single Dose of Aspirin Effective in Relieving Migraine Pain.” And, millions of people take 81 mg of aspirin every day for heart health.
Now, a new study in The Lancet indicates that “aspirin may be much more effective than anyone knew at helping prevent cancer deaths.”
The stunning finding came while researchers were studying 25,000 people taking daily aspirin to prevent heart disease. It turns out aspirin was doing something else, reducing the death rate from cancer as well.
In fact, in the trials where people have taken aspirin four, five, six, seven years on average, the risk of dying of cancer was reduced by about 25%.
So, you may ask, “Should everyone take low-dose aspirin?”
The American Cancer Society said no and that “it would be premature to recommend people start taking aspirin specifically to prevent cancer,” considering that “even low dose aspirin can lead to dangerous internal bleeding. Still, evidence that it might help fight cancer is intriguing for doctors.”
Even so, in the Lancet study, daily aspirin use appeared to lower the risk of death from cancer by 21% in randomized trial participants. It’s important for me to point out that the findings, by themselves, do not prove that aspirin prevents cancer or even cancer death and that the role of aspirin as a chemoprevention agent needs clarification by further studies.
Nevertheless, researchers at Oxford reached the conclusion that a daily low-dose aspirin could significantly lower cancer deaths. They came to that conclusion after examining “the cancer death rates of 25,570 patients who had participated in eight different randomized controlled trials of aspirin that ended up to 20 years earlier,” the New York Times reports.
“Participants who had been assigned to the aspirin arms of the studies were 20 percent less likely after 20 years to have died of solid tumor cancers than those who had been in the comparison group taking dummy pills during the clinical trials, and their risk of gastrointestinal cancer death was 35 percent lower. The risk of lung cancer death was 30 percent lower, the risk of colorectal cancer death was 40 percent lower, and the risk of esophageal cancer death was 60 percent lower.”
Only “one-third of people in the analysis were women — not enough to calculate any estimates for breast cancer,” the AP points out.
And, “there appeared to be no benefit to taking more than 75 milligrams daily — roughly the amount in a European dose of baby aspirin and a bit less than the baby aspirin dose in the US.”
In addition, “aspirin was not found to [significantly] influence the risk of death from pancreatic, prostate, bladder, kidney, brain, or blood cancers,” the Los Angeles Times reports.
Yet, lead investigator Dr. Peter M. “Rothwell noted that most of the subjects stopped taking aspirin at the end of the study – or, alternatively, many in the control group began taking it — potentially confusing the results.” He added that “‘it’s likely that if people had carried on taking aspirin,’ the benefit would have been greater.”
Rothwell also said that “healthy middle-aged men and women may benefit the most from taking aspirin over a long period,” and medical guidelines “may be updated on the back of these results,” Bloomberg News reports.
Meanwhile, an 80-year-old expert at Cardiff University “who has published 300 research papers over 50 years” said, “The man on the street knows betting odds.” Peter Elwood, “who has been taking aspirin since 1974 and wasn’t involved in the study,” maintained that “people should ‘evaluate the risks for themselves.'”
But increasingly, my patients, when evaluating the risks and benefits of daily 81-mg aspirin, are choosing to take it.
ABC World News reported what most of us doctors have known for some time: that “at high doses, aspirin can cause side effects, like bleeding and stomach discomfort;” however, we also know that the “low dose of aspirin a lot of people are already taking for their hearts may reduce the risk of colon cancer by a quarter and deaths from the disease by a third.” Now, new research is confirming these earlier findings.
Indeed, “aspirin should not replace screening tests like colonoscopies, and because it has serious side effects … people should talk to their doctors before taking even a low dose of aspirin on a regular basis,” the CBS Evening News reported. Still, “a daily dose of baby aspirin” over a long period of time may be the way to go, especially if you have a family history of colon polyps or colon cancer.
The recommendation is based on European research in which investigators “pooled the 20-year results of four trials with more than 14,000 people,” the Washington Post reports. “Those studies were designed to study aspirin’s use in preventing strokes, not colon cancer.” The current study authors, however, “tracked who developed the disease through cancer registries and death certificates in Britain and Sweden, where the studies were done.”
Other natural medications that are associated with lower rates of colon cancer include vitamin D and calcium. You can read more about that in some of my previous blogs on the topic:
A single 1000-mg dose of aspirin is an effective treatment of acute migraine headaches for more than half of people who take it, and the addition of 10 mg of metoclopramide (Reglan) may reduce nausea, according to the findings of a literature review published by the Cochrane Database of Systematic Reviews.
Here are the details from MedScape:
“Aspirin plus metoclopramide would seem to be a good first-line therapy for acute migraine attacks in this population,” write Varo Kirthi, MD, and colleagues, with the Pain Research and the Nuffield Department of Anaesthetics at the John Radcliffe Hospital, in Oxford, United Kingdom.
The researchers selected 13 studies, including 4222 participants, that were randomized, double-blind, placebo-controlled, or active-controlled; evaluated the use of aspirin to treat a single migraine headache episode; and included at least 10 participants per treatment group.
In addition, studies compared aspirin 900 mg or 1000 mg (alone or in combination) and metoclopramide 10 mg vs placebo or other active comparators (typically sumatriptan 50 mg or 100 mg).
Compared with placebo, aspirin reduced associated symptoms of nausea, vomiting, photophobia, and phonophobia.
A single 1000-mg dose of aspirin reduced pain from moderate or severe to no pain by 2 hours in 24% of people vs 11% taking placebo.
Severe or moderate pain was reduced to no worse than mild pain by 2 hours in 52% taking aspirin vs 32% taking placebo.
Headache relief at 2 hours was sustained for 24 hours more often with aspirin vs placebo.
In addition, metoclopramide, when combined with aspirin, significantly reduced nausea (P < .00006) and vomiting (P = .002) vs aspirin alone, although it had minimal effect on pain.
Fewer participants taking aspirin needed rescue medication vs those taking placebo.
Adverse events were reported more often with aspirin vs placebo but were mostly mild and transient.
The review also found that aspirin alone was comparable to the prescription medication sumatriptan 50 mg for 2-hour pain-free relief and headache relief, whereas sumatriptan 100 mg was superior to aspirin plus metoclopramide for 2-hour pain-free, but not headache, relief; no data comparing sumatriptan with aspirin for 24-hour headache relief were available.
“Aspirin plus metoclopramide will be a reasonable therapy for acute migraine attacks, but for many it will be insufficiently effective,” noted study author R. Andrew Moore, DSc, in a written release.
“We are presently working on reviews of other OTC [over-the-counter] medicines for migraines, to provide consumers with the best available evidence on treatments that don’t need a prescription,” he said.
Here’s a good news story for those of us who suffer with migraine headaches. According to two new studies, migraine sufferers may be able to get sufficient relief without turning to prescription drugs.
The studies, published in the latest issue of the journal Headache, conclude that naproxen (marketed over-the-counter [OTC] as Aleve) and acetaminophen (Tylenol and others) effectively decreased or eliminated pain and reduced migraine recurrence and migraine-associated symptoms to a degree defined as a “desirable outcome” of migraine therapy by the International Headache Society.
Here are more details from Reuters Health:
Migraine headache affects as many as 28 million Americans and costs the U.S. economy an estimated $24 billion every year.
About three-quarters of people who suffer from migraines report more than one migraine a month. The symptoms — pain, light and noise sensitivity, nausea — can last from 4 to 72 hours and often lead to missed days from school or work.
Researchers from Thailand analyzed four well-designed previous studies of naproxen at doses of 500 to 825 milligrams for treatment of acute moderate to severe migraines involving 2,168 patients.
Led by Chuthamanee Suthisisand of Mahidol University in Bangkok, the authors concluded that naproxen effectively reduced headache intensity, pain and symptoms within 2 hours of taking it – defined by the International Headache Society as a desirable outcome.
When compared to other drugs known as triptans, naproxen did as well as the prescription drug frovatriptan (marketed as Frova) but did not offer the same clinical benefits as almotriptan (marketed as Axert) and zolmitriptan (marketed as Zomig).
However, because of side effects, not all patients can take triptans, and naproxen offers those patients a non-prescription alternative, Suthisisand told Reuters Health by email.
Still, the authors found that naproxen “appears to be inferior” to aspirin in treating migraines. Suthisisand said the science suggests 1,000 milligrams of aspirin is the best of several treatments that include naproxen and acetaminophen for acute moderate to severe migraine episodes, as long as patients can tolerate potential gastrointestinal side effects.
Although the Thai team acknowledged that the quality of studies such as theirs depends on the quality of the original studies, they said they were confident the studies they reviewed were high-quality.
In the second study, researchers from McNeil Consumer Healthcare, the makers of Tylenol, randomly assigned 378 migraine sufferers to either 1000 milligrams of Tylenol or a dummy pill.
In the 90-day trial, the researchers, led by Mary Jane Prior, found that the Tylenol group began to benefit within an hour of taking the medication. At 2 hours, 52 percent of the acetaminophen group reported that their pain was reduced to mild or no pain, compared to 32 percent of the dummy pill group.
The team also reported a benefit for severe pain sufferers, but they could not determine whether that was due to chance, given the small number of patients in the trial.
The study also found that acetaminophen offered “significantly larger” relief than placebo from nausea and noise sensitivity at 2 hours and nausea, light and noise sensitivity and functional impairment at 6 hours.
The study, the authors concluded, adds to earlier clinical evidence supporting acetaminophen’s use to treat migraine.
“When effective,” the authors wrote, “acetaminophen provides consumers with a non-prescriptive, lower cost alternative to costly prescription migraine drugs.”
Acetaminophen is not currently approved by the FDA as a migraine treatment except as part of an aspirin or aspirin and caffeine compound. McNeil Consumer Healthcare declined to say whether they were applying to the FDA for approval of acetaminophen for use in migraine.
The folks at Natural Standard recently sent out a notice of a significant review in the cardiology literature on the potential interactions between herbs and heart medications. A news release on the study can be found here. This new analysis suggests that herbal supplements, such as Ginkgo biloba and garlic, may cause dangerous interactions when combined with heart medications.
Some examples of herbs and their adverse effect on heart disease management include:
- St. John’s wort, which is typically used to treat depression, anxiety and sleep disorders among other problems, reduces the effectiveness of medications contributing to recurrences of arrhythmia, high blood pressure or increase in blood cholesterol levels and risk for future heart problems.
- Ginkgo biloba, which is supposedly used to improve circulation or sharpen the mind, increases bleeding risk in those taking warfarin or aspirin.
- Garlic, which supposedly helps boost the immune system and is commonly used for its cholesterol and blood pressure lowering properties, can also increase the risk of bleeding among those taking warfarin.
The authors searched PubMed and Medline databases for articles about herbs and heart disease that were published in 1966-2008. They identified nearly 30 herbal products that could cause harmful effects and should not be taken with heart medications, including those that lower blood pressure, prevent blood clots, regulate cholesterol and stabilize heart rhythms.
Bleeding was among the most common interactions that were reported. The authors found that alfalfa, angelica (dong quai), bilberry, fenugreek, garlic, ginger, ginkgo and khella may increase the risk of bleeding when taken with anticoagulants like warfarin (Coumadin®). The researchers also identified herbs (such as capsicum, ginseng, licorice, St. John’s wort and yohimbine) that may increase blood pressure.
Grapefruit juice may also cause dangerous interactions. The fruit inhibits an important enzyme that helps break down drugs. As a result, grapefruit may increase the amount of medication in the body to toxic levels.
According to the researchers, grapefruit juice may increase the effects of cholesterol-lowering drugs (statins), blood pressure-lowering drugs (calcium-channel blockers) and cyclosporine (a drug that reduces the risk of transplant rejection).
“There is a clear need for better public and physician understanding of herbal products through health education, early detection and management of herbal toxicities, scientific scrutiny of their use, and research on their safety and effectiveness,” the authors concluded in the Journal of the American College of Cardiology.
“These herbs have been used for centuries—well before today’s cardiovascular medications—and while they may have beneficial effects these need to be studied scientifically to better define their usefulness and, more importantly, identify their potential for harm when taken with medications that have proven benefit for patients with cardiovascular diseases,” said Dr. Jahangir, one of the authors of the study.
“Patients, physicians, pharmacists and other healthcare providers need to know about the potential harm these herbs can have.”
In addition to greater public education about the risks of using herbal products, patients and clinicians need to actively discuss the use of over-the-counter medications, supplements and herbal products in addition to prescription medications.
Dr. Jahanigir also urges the scientific community to commit to conducting studies to test manufacturers’ claims and study the impact of these compounds on heart disease management. He reports no conflict of interest.
Obviously, like conventional drugs, herbs and supplements may cause side effects and interact with other therapies and you should never take natural medications (herbs, vitamins, and supplements) with prescription or even OTC drugs without checking with your physician or pharmacist.
You can read more herbs and natural medicines in my book, Alternative Medicine: The Christian Handbook:
BBC News reports that “low-dose aspirin should NOT routinely be used to prevent heart attacks and strokes,” according to research published in the Lancet. So, if you are on a daily aspirin for primary prevention of a heart attack or stroke, should you stop taking it?
More Information: Continue reading
Aspirin and ibuprofen are staples in just about every medicine chest and first aid kit. They’re sold over the counter, and they’re not expensive. Most people don’t think twice about taking them. But you should — especially if you’re elderly.
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On the March 30th edition of the ABC World News, Charles Gibson reported, “Some of the country’s leading heart doctors heard results” yesterday at the American College of Cardiology (ACC) conference “about … just one pill that could revolutionize the way heart disease is treated. This pill combines five commonly used medications, and new findings show it to be safe and effective.” Should you get your doctor to prescribe this to you?
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