Should I take aspirin?

More Aspirin Data, Less Data for Aspirin

There have been a few articles that came out in the New England Journal in the last month or two on aspirin and while I've talked about this a little before, it warrants a review.

Back when there wasn't much of anything to help prevent heart attacks and strokes, aspirin was great. For people who are having a heart attack, it's great for treating it. And for people who have had a heart attack or a stroke or anything where their arteries are suddenly blocked, aspirin is still very good to prevent a recurrence.

One issue with the evidence FOR aspirin is that most of the data came before the age of statins, which reduce the amount of cholesterol in the arteries and also help stabilize the cholesterol plaques that are already there and keep them from breaking off and causing artery blockages in the heart or brain (the main cause of most artery blockages). So it had been tough to sort out how much EXTRA benefit people on statins got from also taking an aspirin.

BUT everyone is always looking for the best way to prevent their first one of these (called primary prevention) and for a long time I think people were just being told if you're over 40, take an aspirin. In recent years, that recommendation had been dialed back to just people over 50 who are at higher risk for heart attacks and strokes.

One new study looked at people with diabetes taking aspirin, as diabetes is considered to be as much of a risk for having a heart attack as having already had a heart attack before. This study did not find any benefit though and actually saw harms related to bleeding episodes as aspirin is a blood thinner.

The other study looked at people over 70 (or over 65 if they were African American or Hispanic) taking a daily preventative aspirin as there wasn't good data on this group and also found no real evidence of benefit and the same harms of causing bleeding episodes.

I think the leaning now is to not have people on aspirin for primary prevention. It may still be useful for people with uncontrolled blood pressure and cholesterol who smoke, but really at that point there's probably better return on your investment for focusing on the things working against your heart health than there is taking a medication thinking it fixes the problems.

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen). Those are the over-the-counter ones. Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on. All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation. However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock. every other organ system that you have. The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before. For women who have had children, they generally know what a 10 is, but for men it's a little harder. When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?" The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth. The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance. Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child. For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was. Fortunately, there were researchers who had a yen to poke peopl...

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