Should everyone over 50 take aspirin prophylaxis?
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7505.0-c (Published 16 June 2005) Cite this as: BMJ 2005;330:0-cAll rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I strongly agree with the position of Colin Baigent in respect of the
benefits and risks of aspirin(1).
Particularly the benefit of the primary prevention to my opinion is
still uncertain.
Let me add two more aspects:
First, in three (2-4)of the six "primary prevention" trials(2-7)patient
with symptoms or manifestations of a cardiovascular disease were included.
In the HOT-study(4) about 16% (3.080/18.790)(8, 9), in the BMD-
Trial(2)about 6% and in the PHS(3) about 1%. For this group of patients
the therapy with aspirin was a secondary prevention, which benefits are
undoubted (10). So the enclosure of this patients and of these studies in
the metaanalyses (11, 12, 13) concerning the primary prevention, leads
presumably to an overestimation of the benefit of aspirin for this
indication.
The second aspect is, that non of the studies mentioned above shows a
definit subpopulation regarding to riskfactors or -markers like type 2
diabetes, BMI, Hypertonus, number of risk factors etc., that has a special
or accessory benefit from primary prevention with aspirin compared to the
control(with exception of the subpopulation of women aged 65 or older in
the WHS(7)). The results of the analyses differ and show no
constance(7,14,15).
So, an risk adapted indication, like recommended by different guidelines,
seems difficult, especially the validity of the instruments of risk
estimation differs between different countries or even regions.
Reference:
1.BMJ 2005;330:1440-3
2.Br Med J 1988;296:313-6
3.N Engl J Med 1989;321:129-35
4.Lancet 1998;351:1755-62
5.Lancet 1998;351:233-41
6.Lancet 2001;357:89-95
7.N Engl J Med 2005;352:1293-304
8.Correspondence. Lancet 1998;352:571-72
9.Correspondence. Lancet 1998;352:574
10.BMJ 2002;324:71-86
11.Arch Inter Med 2003;163:2006-10
12.Ann Intern Med 2002;136:161-72
13.Heart 2001;85:265-71
14.BMJ 2000;321:13-7.
15.Journal of Hypertension 2000;18:629-42
Competing interests:
None declared
Competing interests: No competing interests
Are we medicating a nutritional deficiency?
If as many as 80% of men and 50% of women over 50 will benefit from
taking aspirin then perhaps a non disease approach should be considered.
Can the effects of aspirin be mimicking a nutrient missing in our
(modern/civilised) diet?
As reported in the New Scientist (Issue 2334), organically grown vegetable
soups contain almost six times the amount of salicylic acid as non-organic
vegetable soups.
It is also notable that many commonly used medicinal herbs contain
substances that the body biotransforms to salicylic acid, for example
salicin is found in Salix spp., Populus spp., Viola spp, and Viburnum
spp., fraxin is found in Fraxinus spp., and both spiraein and
salicylaldehyde are found in Filipendula spp.
These are substances are biotransformed after passage through the stomach
and so are not associated the risks of gastrointestinal bleeding as is
aspirin.
Competing interests:
Distributer of herbal and nutritional products
Competing interests: No competing interests