Don’t rely on aspirin for cardiovascular protection

JAMA 030310There’s another study just published in the Journal of the American Medical Association (JAMA) providing evidence that aspirin does not prevent a heart attack or stroke in the general population. The authors selected 3350 higher risk adults adults from a pool of 28,900 men and women by choosing those with a low ankle brachial index (ankle/arm pressure pressure ratio):

“A low ankle brachial index (ABI) indicates atherosclerosis and an increased risk of cardiovascular and cerebrovascular events. Screening for a low ABI can identify an asymptomatic higher risk group potentially amenable to preventive treatments.”

According to their study design they gave once daily 100 mg aspirin (enteric coated) or placebo…

“To determine the effectiveness of aspirin in preventing events in people with a low ABI identified on screening the general population.”

After analyzing all the data collected over a 10 year study period, this is their conclusion:

“Among participants without clinical cardiovascular disease, identified with a low ABI based on screening a general population, the administration of aspirin compared with placebo did not result in a significant reduction in vascular events.”

However, there are evidence-based interventions free of side-effects associated aspirin (GI bleeding) that have been demonstrated to reduce risk factors. These can be applied on an individual basis with the functional medicine approach that uses science and technology to objectively identify personal vulnerability and need.

Aspirin can decrease recurrence of breast cancer

Journal of Clinical Oncology 031010A paper entitled Aspirin Intake and Survival After Breast Cancer was just published in the Journal of Clinical Oncology.

“Animal and in vitro studies suggest that aspirin may inhibit breast cancer metastasis. We studied whether aspirin use among women with breast cancer decreased their risk of death from breast cancer.”

Considering the seminal role that chronic inflammation plays in cancer this was a plausible connection to test.

“Among women living at least 1 year after a breast cancer diagnosis, aspirin use was associated with a decreased risk of distant recurrence and breast cancer death…This association did not differ appreciably by stage, menopausal status, body mass index, or estrogen receptor status.”

But aspirin can have significant side-effects. Are there agents that may confer similar benefit but, along with being free of side-effects, do even more good? The evidence indicates there are.

ToxicologyConsider this paper entitled Curcumin, resveratrol and flavonoids as anti-inflammatory, cyto- and DNA-protective dietary compounds recently published in the journal Toxicology. Cyto- and DNA-protective means that they protect against the kind of damage that can cause cells to mutate into cancers. This is one of many studies on curcumin, resveratrol and other substances showing that…

“…their intake was related to a reduced incidence of cancer, cardiovascular, neurological, respiratory, and age-related diseases… The polyphenols afford protection against various stress-induced toxicities through modulating intercellular cascades which inhibit inflammatory molecule synthesis, the formation of free radicals, nuclear damage and induce antioxidant enzyme expression. These responses have the potential to increase life expectancy.”

Anticancer ResearchHowever, here is a critical key point: a certain level of inflammation also protects against cancer. Our bodies are producing abnormal cells all the time. One of the jobs of the immune system is to recognize and eliminate them. It gets rid of abnormal cells, like pathogens, with inflammation. More mutated cells that have accumulated DNA damage is one of the reasons why the level of inflammation goes up with age. This brilliant paper entitled Tumour Biology: Tumour-associated Inflammation versus Antitumor Immunity was recently published in the journal Anticancer Research. Here the author is explaining that abnormal inflammation is involved in causing cancer, while at the same time an inflammatory response is required to get rid of it:

“From the immunological point of view, the main characteristics are dysregulated inflammatory conditions caused by the tumour cells themselves or by external factors, depending on the type of tumour event. It is evident that prolonged dysregulated inflammatory conditions favour not only carcinogenesis but also the local infiltration and metastasis of malignantly modified cells and counteract the development of efficient antitumor immunity. On the other hand, there are indications that through the polarisation of immunological reactions, the ability of immunological regulator and effector cells to induce efficient antitumor immunity can be modulated.”

This is why working with someone who is skilled in the functional approach to evaluating immune function with the appropriate lab tests for inflammatory and protective cytokines and T cell (white blood cell) sub-populations to determine appropriate support is so important.

Aspirin does not reduce heart attacks with diabetes

The investigators who conducted this meta-analysis published in the British Medical Journal selected 6 eligible studies comprising 10,117 participants with diabetes and found: “When aspirin was compared with placebo there was no statistically significant reduction in the risk of major cardiovascular events…A clear benefit of aspirin in the primary prevention of major cardiovascular events in people with diabetes remains unproved. Sex may be an important effect modifier.” Some benefit was found for men (none for women) but “the expected benefits might not exceed the risk of major bleedings….We cannot recommend using aspirin in the primary prevention of cardiovascular events in all patients with diabetes without additional evidence…”

Aspirin should not be routinely used for the prevention of cardiovascular disease

The investigators who authored this report concluded that aspirin “should not be routinely initiated” for the primary prevention of cardiovascular disease, and its use should be reviewed for patients already taking aspirin. After analyzing a number of studies they conclude that the evidence “does not justify the routine use of low-dose aspirin for the primary prevention of [cardiovascular disease] in apparently healthy individuals, including those with elevated blood pressure or diabetes…there have been doubts about whether any benefits of aspirin…outweigh the risks (e.g. the fact that long-term low-dose aspirin therapy almost doubles the likelihood of gastrointestinal haemorrhage).” There are excellent alternatives to aspirin for preventing too much blood clotting and reducing inflammation.