The real story on taking daily aspirin

September 24, 2018

At first we were a little concerned about our aspirin recommendations, after a study on aspirin and heart disease prevention was published online in The Lancet. News headlines declared the findings showed that taking a daily low-dose aspirin wasn’t much help in protecting you from heart disease. One example: “Study: Daily aspirin won’t prevent first heart attack.”

But after reading the actual study — not the news reports — we discovered that the headlines should have declared: “Study finds aspirin won’t prevent first heart attack unless taken as directed.”

So, here’s how we think you should talk to your doc about taking or continuing to take low-dose aspirin in order to prevent a first heart attack or stroke — and other health woes.

Just to be clear, there is a preponderance of data that shows people — especially guys over 40 who don’t do extreme sports and women over 50 — who take a low-dose aspirin or more a day (we say there’s a benefit to doing so morning and night) have a 10 to 40 percent decrease in the risk of nine cancers, including cancer of the breast, colon, esophagus, rectum and more, and a 10 to 35 percent reduction in recurrent heart attacks or strokes.

The study in question: The ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events) study that’s being touted as an aspirin-debunker only required folks in the aspirin-taking group (more than 6,200 people from Germany, Italy, Ireland, Poland, Spain, the U.K. and the U.S.) to do so 60 percent of the time — and many of them failed to do even that! The researchers admit, some folks in the control group who were supposed to not take aspirin did so.

Overall, of around 12,550 folks who were randomly assigned to either the aspirin-takers or no-aspirin-takers group, only 7,800 actually did what they were supposed to do! (Men were 55 and older and had two risk factors for coronary heart disease, such as elevated LDL cholesterol or hypertension; women were 60 and older and had three risk factors.)

But that’s not the whole story.

Among folks in the ARRIVE study who stuck with the prescribed dose of 100 mg aspirin daily, there was a 47 percent reduction in initial or first heart attacks! The aspirin had significant benefits. Clearly, being a tad compulsive about taking your meds, in this case aspirin, is a very, very good thing.

Yet more proof: ARRIVE’s findings came out on the same day the ASCEND study confirmed that taking daily aspirin prevents primary vascular events (that’s a first heart attack or stroke) in folks with diabetes, although it also increased bleeding risks. For the 30.3 million Americans living with diabetes — and we say the other 69.7 million with prediabetes — it may be possible to modify the risk of heart disease (the No. 1 killer of folks with diabetes) if they take 100 mg of aspirin every day.

So what’s the real story? We continue to recommend (if your doc says it is OK) taking an 81-mg aspirin twice a day with half a glass of warm water before and after, as long as you do not do extreme sports or some other activity, such as taking recreational drugs and some prescription meds or have medical conditions, such as uncontrolled liver or kidney disease, that decrease the benefits of the aspirin or increase its risks.

Beware stop and start! It’s risky to start taking aspirin regularly and then forget more than one dose (what the ARRIVE participants apparently did). If you do that, you’ll trigger a rebound increase in clotting. (A rebound also happens in cholesterol levels if you miss more than two doses of a statin and in blood pressure if you skip your antihypertensive meds.) And that rebound increases your risk of heart attack and stroke.

So if you’re a guy 40+ or a woman 50+ without added risks, and your doc agrees, start and stick with a daily aspirin regimen.

Q: Is it true that there are new treatment guidelines for Type 2 diabetes? My wife was recently diagnosed, and I want to know what they are.

Lester G., Columbus, Ohio

A: Yes, there are new guidelines, or a realignment of guidelines, and there are a few things you and your wife need to talk to her endocrinologist about.

The big shift is that doctors are being told to approach their Type 2 diabetes care plan by starting with an evaluation of each diagnosed patient’s heart health, because cardiovascular disease (heart attack and stroke) is the No. 1 cause of death for people with diabetes. While metformin remains the recommended first-line treatment for Type 2 diabetes, there are two types of therapies that are emerging as the go-to drugs for managing long-term heart health and blood glucose levels: sodium-glucose cotransport-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.

One caution: The Food and Drug Administration has issued a warning about SGLT2 inhibitors, because from March 2013 to May 2018, they found five women and seven men were hospitalized (one died) with what’s known as necrotizing fasciitis of the genitals (flesh-eating bacteria) because of taking the meds. (1.7 million people received prescriptions for SGLT2 inhibitors in 2017). Going forward, a warning label will be placed on the medication. So ask the doctor about the risks and benefits for your wife.

As for the emphasis on cardiovascular health, that’s terrific. But it doesn’t depend on medicines alone! She should make sure to get 10,000 steps daily, lose 10 percent of her body weight if she is overweight, avoid all added sugars and syrups, sat and trans fats and highly processed foods. You can reverse Type 2 diabetes with a healthful lifestyle, then neither of you will have to worry about the potential side effects of Type 2 diabetes medications.

Q: My husband and I weigh about the same, are both 45 and about the same height and weight (5 feet, 8 inches, and 150 pounds). Should we eat the same kinds and amounts of foods?

Shirley D., St. Joseph, Mo.

A: Height and weight are not the only criteria that determine how much and what foods you should eat. Your nutritional needs also are influenced by your activity level, age and your gender.

Are you active? While a 45-year-old sedentary woman who is 5 feet, 8 inches tall and weighs 150 pounds may burn 1,934 calories a day or less, an active woman with the same stats can consume 2,445 calories and maintain her weight. (An active man with the same stats — 2,752 calories.) So you want to tailor what you eat to your activity level and your desired weight.

Are you in perimenopause or menopause? That often ushers in weight gain. So you want to change what and when you eat. Smart steps: Wait 13 or more hours between dinner and breakfast; eat a lean-protein, fresh fruit and 100-percent-whole-grain breakfast; and never have dinner (light and lean) later than 8 p.m.

Are you happy? A study published in Nutritional Neuroscience found that women’s brains require an especially nutrient-rich diet to achieve maximum happiness and mental health. Seems as men and women evolved, their brains developed anatomical and functional differences that influence susceptibility to mental disease. The bottom line is, “women need a larger spectrum of nutrients to support mood, compared to men,” and many are not getting them. That, the researchers suggest, may explain why women are more prone to depression and anxiety than men are.

So it’s important that women (and men too!) avoid highly processed foods, added sugars and additives that can alter gut bacteria and the nutritional balance in the body. They need to make sure they get iron-rich food (premenopause especially), like chicken, turkey, fish, kale, spinach, beans and lentils; folate-rich citrus fruits, leafy greens, beans and peas; calcium-rich, nonfat dairy, sardines, tofu and dark leafy greens; and vitamin D from fatty fish like salmon and all varieties of mushrooms.

Contact Drs. Oz and Roizen at youdocsdaily@share.com.

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