Mar 26, 2019

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

How does my butt look in these pants? No really, have a look. I want you to. It should save me some embarrassment later. When I think about all the places I went on Friday, it makes me shutter a little. I had an unplanned trip to the high school to talk to Emily. I talked to that tow truck driver. Back at the pharmacy I talked to umpteen patients and co-workers. No one said anything. It wasn't until I got home that I noticed the enormous ... well not really a tear. Maybe a separation, or unravelling? I haven't really seen pants do that before.

ASA has been in the news lately for possibly not covering us like we thought it did. A long time, good customer of the Pharmacy from the McCreary area called last week to talk to Pat. She saw something on the news that concerned her. She asked Pat what was going on with ASA killing all the seniors. Pat told her he hadn't heard that on the news, but he'd get me to look into it for her. So, the short answer is - ASA isn't killing seniors. The longer answer is the American Heart Association released a statement saying in part "If you're over 70, taking aspirin to prevent a first heart attack or stroke could do more harm than good."

Let's step back a bit first. ASA does interesting things in the body. It affects the enzyme cyclooxygenase and this decreases the pro-inflammatory chemicals the prostaglandins. We think that decreasing these prostaglandins is what causes ASA to be able to decrease pain and inflammation. We think that the decrease of the prostaglandin E1 in the brain is what causes ASA to be able to decrease fever. ASA also affects platelets. Platelets help your blood to clot. ASA stops the cyclooxygenase enzyme in the platelet from forming thromboxane. This permanently disables the platelet from being able to clot for the life of the platelet which is 7 to 10 days. This ability of ASA to hinder the blood from clotting is why we give ASA to people to prevent heart attacks and strokes. A blood clot in the wrong place is the cause of many heart attacks and some strokes.

The Heart Research Institute says every 7 minutes someone in Canada dies of heart disease or stroke. If ASA prevents heart attacks and strokes and it is very inexpensive, why shouldn't we put all adults on it? That is what the American Heart Association statement is getting at. Yes, ASA prevents heart attacks and strokes, but does it do some bad stuff too. Let's look at an example. People with diabetes are more likely to get a heart attack or stroke than people without diabetes. But, ASA's benefits are nearly a wash in patients with diabetes. Using aspirin for about 7 years may avoid a cardiovascular event in one in 90 patients. That's good, but it can cost a life-threatening bleed in one in 110 patients. So, for people without a previous heart attack or stroke, ASA doesn't seem to give any extra benefit to people with diabetes.

There are some nuances to be aware of here. We need to talk about primary and secondary prevention. Primary prevention is when a person takes a treatment to try to prevent a disease that has never happened before in that person. Secondary prevention is a treatment to prevent a disease that has already happened from happening again. Starting in the 1980's researchers found that people who had heart attacks and strokes were less likely to have a second heart attack or stroke if they took ASA. That is secondary prevention. Everyone still agrees on using ASA for secondary prevention. ASA definitely still reduces the chances of heart attack and stroke in people who have had one already.

But back to ASA and seniors. The new recommendations from the American Heart Association were probably at least partially based on a recent study. JJ McNeil et al. published "Effect of Aspirin on All-Cause Mortality in the Healthy Elderly" in the September 16, 2018 New England Journal of Medicine. They looked at healthy people 70 years and over in the US and Australia with no heart disease, dementia or disability. They had 19,114 people enrolled. Half got ASA 100 mg and half got placebo. They were followed for almost 5 years. And the placebo group did not die more often than the ASA group.

What does this study tell us? They looked at healthy older people because they should be the most likely to benefit from ASA. And they didn't. This adds to the evidence that low dose ASA doesn't prevent enough heart attacks and strokes in people without heart disease to justify giving it to everyone.

Should I throw out my ASA? Of course not. Remember the study were surprisingly healthy 70 plus year olds. No heart disease, no dementia, no other disabilities. Healthy 70 and 80 years olds exist, but most of the people that age who see me in the pharmacy have diabetes, and/or a previous heart attack, and/or previous mini-stroke, and/or a stent and/or an irregular heart beat, and and and. We do know ASA is good a preventing a second (or third or fourth) heart attack or stroke. Most of the people I talk to on ASA already have a heart condition of some kind. They should definitely not stop their ASA. If you are on ASA now, talk to your doctor before stopping it. If you've never taken ASA before and want to start, talk to your doctor first.

When I took off my pants after work, way too much light came through the butt. They didn't tear along the seam, but just to the left something weird had happened. All horizontal threads were still intact, but all the vertical threads were missing for a half covered gap an inch wide and at least 12 inches long. It was huge. The next questions were, "When did this happen?" and "How many people noticed?" So, if I flashed my under wear at you, sorry. If everyone noticed and didn't say anything, shame on you. Today, though, I have only one question. How does my butt look in these pants?

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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