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Daily Low-Dose Aspirin May Help Some People

By Dennis Thompson
HealthDay Reporter

MONDAY, Sept. 16, 2019 (HealthDay News) — Debate over the benefits and drawbacks of daily low-dose aspirin has flared in recent years, with guidelines now generally urging against the regimen to prevent a first heart attack or stroke in healthy people.

But some people with good heart health still might benefit from taking daily low-dose aspirin, a new study from New Zealand argues.

About 2.5% of women and 12% of men would likely benefit from daily aspirin during a five-year period, based on an analysis of more than 245,000 heart-healthy New Zealand residents.

“In our study, we were able to predict for each individual, by taking into account their personal characteristics, their propensity to benefit from or be harmed by aspirin,” said lead researcher Vanessa Selak, an epidemiologist with the University of Auckland in New Zealand.

“Using this personalized approach enabled us to identify specific individuals who were likely to benefit from aspirin after weighing up aspirin’s effects on both cardiovascular events and serious bleeding,” Selak continued.

That would seem to contradict new guidelines issued earlier this year by the American Heart Association (AHA) and the American College of Cardiology (ACC).

The two groups concluded that for older adults with healthy hearts, the risk of bleeding that comes with aspirin therapy outweighs any heart benefit.

“We used to say aspirin generally yes, occasionally no. Now we say aspirin generally no, occasionally yes,” said Dr. Amit Khera, who served on the ACC/AHA committee that wrote the guidelines.

However, Khera feels this new study actually supports the new guidelines.

“This modeling exercise confirmed it’s a very small group of the population that potentially could be eligible for aspirin,” said Khera, a professor of cardiology with UT Southwestern Medical Center in Dallas.

These guidelines are not for people who’ve had an emergency regarding their heart health. Those people do derive overall benefit from aspirin, he said.

“If you’ve had a heart attack or stroke, continue to take your aspirin,” Khera said.

But clinical trial data that emerged in 2018 showed that daily aspirin taken by people in good heart health only reduces their risk of heart attack and stroke by 11%, but increases their risk of dangerous bleeding by 43%, he added.

Continued

“I want to be clear that I’m not talking about nosebleeds,” Khera said. “I’m talking about needing a transfusion, being hospitalized, bleeding in the brain. Big stuff.”

To take a closer look at the potential benefits of aspirin, Selak and her colleagues studied hundreds of thousands of New Zealanders without heart disease who had their heart health risk calculated between 2012 and 2016.

The net effect of aspirin was calculated for each person by subtracting the number of heart emergencies the person was likely to have over five years from the number of major bleeds aspirin could cause.

After personalizing the risk-versus-benefit calculation, the researchers found that a select group of people would have a net benefit from aspirin if one heart health emergency that led to hospitalization or death was considered equal to one major bleed that led to hospitalization or death.

The percentages increased to 21% of women and 41% of men if a heart health emergency was considered equal to two major bleeds, the findings showed.

“This research suggests that decisions regarding the use of aspirin among people who have not already had a cardiovascular event should be made after undertaking a personalized prediction of cardiovascular benefits and bleeding harms from aspirin,” Selak said.

That’s already standard procedure under the U.S. guidelines, Khera said.

“No one is saying aspirin doesn’t help. It just doesn’t help as much as we used to think, and you have to appreciate the bleeding penalty,” Khera said. “Some people are more concerned about heart attack risk and are willing to pay the bleeding penalty, especially if they’ve never had any bleeding problems. It’s still OK for them to consider it.”

Both Selak and Khera recommended that people talk with their doctor about the risks and benefits before starting to take daily aspirin. Calculators are available that help physicians weigh your risk of heart attack and stroke against the risk of bleeding.

“In many ways, people think of aspirin as this benign thing because it’s been around for centuries. Anybody can get it over the counter,” Khera said. “But if you’re going to take it every day for the next couple of decades, there are definite penalties to it.”

The new study was published online Sept. 17 in the Annals of Internal Medicine.

WebMD News from HealthDay

Sources

SOURCES: Vanessa Selak, Ph.D., epidemiologist, University of Auckland, New Zealand; Amit Khera, M.D., professor, cardiology, UT Southwestern Medical Center, Dallas; Sept. 17, 2019,Annals of Internal Medicine, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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Ask a Stoner: Infusing Cannabis Into a Daily Diet

Dear Stoner: I’ve recently come upon a lot of trim, and would like to make different kinds of cooking oils and eventually replace smoking with eating infused meals. Suggestions?
Let’s Eat

Dear Eater: You’re swimming in risky waters until you figure out how to dose yourself. Making infused butter or cooking oils with trim (or any homegrown cannabis) is hard to measure unless you bought it from a dispensary with the THC or CBD testing results on it. If you did, weigh out your trim, then calculate your cannabinoid percentage based on 1,000 milligrams per gram. If it is homegrown or untested, then you’ll have to play guinea pig.

Cooking with cannabis is both art and science.

Cooking with cannabis is both art and science.

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Upon calculating dosage, make several different types of fats for cooking (butter, vegetable oil and olive oil, depending on how much pot you have), then start thinking about ways to include them in your daily meals — scrambled eggs, salad, baked chicken and so on. There’s no limit to dishes that require butter or oil, so think beyond baked goods. Peanut butter (or anything with a lot of fat) is another easy infusion option for daily consumption. It’s a layer science added to the art of cooking, but once you figure it out, smoking will be in the rearview.

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Send questions to marijuana@westword.com.


Toke of the Town

For Women With HIV, Daily Life Can Impede Fight Against Virus

FRIDAY, May 17, 2019 — Day-to-day struggles prevent many American women with HIV from taking medicines to suppress the AIDS-causing virus, a new study shows.

“Survival is a priority over putting a pill in your mouth for a number of our participants, and that is the public health challenge we must address,” said study first author Dr. Seble Kassaye, an associate professor at Georgetown University Medical Center in Washington, D.C.

“The truth of their lives is a lot less rosy than a few lines of statistics in a summary report can reveal,” she added in a medical center news release.

The study of nearly 2,000 HIV-positive women in Washington, D.C., New York, Chicago and San Francisco who have been followed since 1994 found that many have been able to control their HIV levels, off and on.

But ongoing challenges such as mental health, unstable housing and lack of social support prevent many from achieving effective and sustained HIV suppression, according to the authors of the study published May 17 in the journal JAMA Network Open.

The women were interviewed and gave blood samples every six months to determine whether their HIV was well controlled or uncontrolled, a condition called viremia.

Over 23 years, 29% were at low probability for viremia; 39% were at intermediate probability; and 32% were at high probability.

Between 2015 and 2017, 71% of women achieved sustained HIV suppression, including 35% with a high probability of viremia, according to the researchers.

“So, the rosy picture is that 71% of the women achieved viral suppression, but the granular detail tells us that some women are doing very well with 89.6% of the women in the low probability of viremia consistently suppressed in the recent years, but others are still struggling to get to viral suppression,” Kassaye said.

Because current HIV drug treatment is much less toxic than it used to be and is now suggested for anyone who has the virus, it’s widely used. But obstacles persist.

The study found that women in the high viremia group were more likely to report depressive symptoms (54%) and have higher levels of illicit drug (41%) and alcohol use (14%). They were also less likely to have stable housing (66%); and more likely to die prematurely (39%).

Kassaye said public health issues and stigma surrounding HIV remain common in Washington, D.C.

“My colleagues have treated generations of HIV-positive women: grandmothers, their daughters, and their granddaughters,” she said. “I have seen women with HIV who do not have any support, but if that person develops cancer, there will be a roomful of people coming to the clinic with her.”

Achieving universal HIV treatment and viral suppression will require what is known as “wraparound” care, she said.

That’s a term for non-medical services to assist patients who may need help taking medications regularly, getting to appointments on time or coping with stress. This safety net can also include help with housing, transportation, child care and the like, according to the global health strategy firm Rabin Martin.

More information

The U.S. Office on Women’s Health has more on HIV/AIDS.

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Posted: May 2019

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