Friday, March 23, 2012

Take Two Aspirin and Don't Call Me In The Mourning

     What if I told you a new drug had been discovered that could dramatically reduce cardiovascular disease, stroke AND cancer, the three leading killers in the US?

     You'd probably think it will take a decade to get FDA approval. Or it must have some ugly side effects.
Or my insurance will never cover it and it must cost a fortune. Or, yeah sure, but do we know what it does to you after 10 or 20 years?

     Well it's already in your medicine chest.

     A series of reports in the British medical journal Lancet has scrutinized the data from many studies involving thousands of patients and demonstrated a very real anticancer effect from aspirin. The investigators examined aspirin trials that had been conducted for vascular disease and noticed that the aspirin groups had far fewer cancer deaths than the placebo groups. Previous studies using similar data mining techniques had shown that after 5 years of taking 75mg (a very small dose) daily the risk of dying from common cancers decreases by 10%-60% depending on the cancer. This includes prostate, lung, colorectal, esophageal and other cancers. This therapeutic effect is not seen in populations who have taken aspirin every other day.

     One analysis in the series published this month on aspirin demonstrated more rapid protective effects in patients who already had cancer. The investigators suggest that this occurs by reducing metastatic disease. In other words, by limiting spread of the cancer.

     This makes theoretical sense. Researchers have known for sometime that platelets, the cells in your blood responsible for clot formation, play a pivotal role in the spread of cancer from its primary site in the body. Aspirin targets platelets.  In addition to an anti-cancer effect, aspirin has an anti-clotting effect that explains its protective action in cardiovascular disease and stroke. It also explains aspirin's one serious side-effect, bleeding.

     Because of the increased risk of bleeding people should consult with a doctor before launching their own trial of aspirin therapy. You should also keep in mind that certain OTC products can increase bleeding risk such as: other anti-inflammatories like ibuprofen, fish oil, angelica, clove garlic, ginger, gingko, Panax ginseng, red clover. tumeric and others.

     While more trials will be necessary before aspirin can be recommended as a primary prevention technique for the general population, this is very promising news.


Wednesday, March 21, 2012

Grade Inflation and The American Cardiovascular Report Card

     A study published this week in the Journal of the American Medical Association examined the correlation between a set of cardiovascular health metrics and death over the past 20 years. This is an important issue because cardiovascular disease (CVD) is the number one killer in the US causing more than 800,000 deaths per year (1 in 3 of all deaths), with an estimated annual overall cost of $444 billion.

     Because sound research has demonstrated a correlation between certain behaviors/lab values and CVD, the American Heart Association (AHA) launched a targeted campaign. The AHA identified three categories of individuals with regard to CVD; ideal, intermediate, and poor.

     No one will be surprised that few americans made it into the ideal category. After all, what does it mean to have ideal cardiovascular health? A heart like Lance Armstrong? 5 minute mile? 50 flights of stairs with a pulse of 60? IDEAL! Right?


     AHA definition of Ideal:

     No Smoking
     Physically Active
     Normal Blood Pressure
     Normal Blood Glucose
     Normal Total Cholesterol
     Normal Weight
     Eating a Healthy Diet

     Pretty ordinary sounding stuff. So here's the knock out. Less than 2 percent of adult Americans meet these criteria.

    There is some good news. Smoking has declined since 1988.

    But the blood pressure and cholesterol categories have not changed, while weight, diet, and blood glucose have worsened.

     People who met 6 or more vs 1 or fewer of these measures had a 51% lower risk of all-cause mortality and a 76% lower risk of CVD. Interestingly, meeting more of the cardiovascular measures was associated with lower risk for all-cancer mortality as well.

     You really only have to nail 3 of the 7. Eat right, don't smoke, and move. The rest follows.