OCTOBER 17, 2008

DON'T PANIC!! KEEP TAKING YOUR VYTORIN! (I MEAN ASPIRIN)!

A study in the British Medical Journal published today showed that aspirin confers no benefit in the prevention of heart attack or stroke, and may increase the risk of bleeding, in patients with diabetes (who are considered at "hi-risk" for these problems)

The prevention of progression of arterial disease and diabetes (POPADAD) trial involved 1276 adults over age 40 with diabetes from 16 hospitals in Scotland. Primary outcome was heart attack or stroke (fatal or non fatal) or amputation because of ischemia. Patients were treated with four variations of combinations of aspirin, antioxidant pills, or placebo. The antioxidant capsule contained alpha-tocopherol 200 mg, ascorbic acid 100 mg, pyridoxine hydrochloride 25 mg, zinc sulphate 10 mg, nicotinamide 10 mg, lecithin 9.4 mg, and sodium selenite 0.8 mg. There were no differences in the primary end point between those treated with aspirin plus antioxidant (58) (18%), aspirin plus placebo 59 (18%), placebo plus antioxidant (59) (18%), or placebo plus placebo (58) (18%), p value=0.92. People who took antioxidants actually had higher mortality, about 23%, compared to those who didn't at about 16%. More people who took aspirin (57) had gastrointestinal bleeding than those who did not (45), difference that was not statistically significant.

POPDAD

The dismal results of this study did not stop a doctor from saying "Don't panic and don't stop taking your aspirin!".

Kind of reminds me of the doc who said "Don't stop taking your..." You've got it. But we know who he was working for.

POPADAD... I wonder who came up with the name of that one anyway. Did you know that they make up the names of the trials, and then try and come up with words that make sense to fit into the initials? But POPADAD is a good one. It's even better than VIGOR or ENHANCE. Kind of like "who's your daddy?" Maybe... the vitamin manufacturer?

Anyhoo, POPADAD's results are yet more news that antioxidant vitamins are not helpful and actually increase the risk of mortality as I have written about before. I have also warned people that the risk of bleeding outweighs the benefit of heart attack prevention for people without heart disease who take a daily aspirin.

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Dan Abshear wrote on Friday Oct 17, 2008

Willow Bark Benefits

An Oldie, But A Goodie

Almost on a daily basis, one may read about a new medication being developed or approved for the benefit of patients. At times, these announcements may praise the innovation and novelty of such new drugs that are available to all in need of it.

But it’s possible the one super drug is not new and really is a super drug. In fact, it’s one of the oldest medications available, and that would be aspirin- the first non-steroidal anti-inflammatory drug (NSAID).

Noted as ASA by doctors typically, aspirin effects have been noted for thousands of years, as the active ingredient comes from the bark of a White Willow tree, and long ago, patients with pain or a fever would chew on this bark for relief. Yet due to the harshness of the natural chemical of this bark, Bayer decided to synthesize it to make it more friendly to the user.

Fast forward to over a hundred years ago and Bayer pharmaceuticals (pronounced ‘Beier’), which is the same company that brought us heroin and mustard gas, as well as methadone. The company originated in Germany, but presently has its U.S. headquarters in New York. Felix Hoffman, seeking to develop an agent for his father’s rheumatism, was involved in the development of what is known now as aspirin. And it was a difficult task to develop this drug, as it was toxic to the stomach due to the nature of the active ingredient again obtained from the bark of the white willow tree. Dr. Hoffman and others at Bayer developed a drug that proved to be tolerable to patients while keeping the active ingredient in tact through a method of delivery developed by Dr. Hoffman’s team at Bayer. After launching the medication, aspirin was priced at about 50 cents an ounce, as at the time it was only available in power form. Soon before 1920, aspirin developed the tablet form of the drug and was then available by prescription. Regardless, aspirin was responsible for one third of sales for Bayer during this time, due to its popularity due to the effects of this medication in need of relief. While all drugs have side effects, aspirin is one of very few drugs that provides great efficacy and indications, with limited side effects. In fact, some of aspirin’s additional uses have been recently discovered. This may be why the New York Times called aspirin a wonder drug in the 1960s. In the 1970s, the mechanism of aspirin was isolated, which is the blockage of prostaglandins.

With Aspirin and its potential life-extending benefits:

Aspirin has been associated with decreased risk of asthma and prostate cancer in the elderly. Also, aspirin has been linked with lowering the risk of breast cancer and colon cancer as well. Aspirin is a blood thinner, and has been associated with decreasing the risk of heart attacks and strokes in certain patient populations, as the drug prevents clots. This was first suggested in the 1940s and the FDA suggested that it be the drug of choice for those who experienced a heart attack over a decade ago. Aspirin intake is beneficial for those after coronary bypass procedures. A topical formulation of aspirin was developed recently for those experiencing Herpes pain. The drug has been proven beneficial for those experiencing migraine pains. Aspirin at low doses is taken by many as a preventive drug to decrease cardiovascular incidents that may occur.

Aspirin has been the best selling painkiller absent of the past addictive qualities of opiate meds since the 1950s. It is also the most studied drug- with over 3000 scientific papers published worldwide. Also, over 15 billion tablets of aspirin are sold annually, which amounts to about 80 million aspirin tablets consumed daily by others. This amounts to over 16,000 tons of aspirin consumed during this time, or about 70,000 metric tons of aspirin a year. Over a decade ago, a study was performed and concluded that twice as many people would choose aspirin over a computer, given the two choices, because of the benefits of the drug.

Side effects would include GI bleeding if taken in large amounts, along with an association of Reye’s syndrome in children, yet both are relatively rare. Yet all things considered, clearly the benefits of aspirin outweigh any risks of the drug.

Lately, there have been issues with other NSAIDs, such as Cox II inhibitors, without full recollection or knowledge that aspirin is in fact the world’s most widely used drug, and for good reasons.

At times, something newer is not always better.

“There is no genius without a touch of madness.” --- Vaslav Nijinsky

Dan Abshear

originally posted on Medical News Today .com