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by didntknowya 921 days ago
although indiscriminate long term aspiring can cause GI side effects
6 comments

Increases risk for hemorrhagic strokes as well. AFAIUI, your clotting ability is impaired, so if you get a minor bleed, it's not minor for long.

IIRC, the recommendations to folks taking aspirin for heart attack prevention is "don't, unless you've already had an ischemic event" because the risk outweighs the benefits for everyone else. That could change if we find new and/or unexpected benefits from low-dose aspirin.

Almost all strokes are ischemic strokes.
yes, hemorrhagic strokes are less frequent, but much worse. I don't think it's quite a wash in the end, but closer to one if all we care about is outcomes (and that's all I do!)
but heart attacks are not strokes
Thank God we cleared that up.
You are welcome, it’s easy to get confused when trying to comprehend passages on the internet.
I am very skeptical about these side effect claims. Do you have hard data supporting this or doctor hearsay. Years ago I remember watching Charlie Rose Brain series where one of the professors said something like “ we know of two drugs that we are certain are very safe for human beings: alcohol and aspirin.”
> “ we know of two drugs that we are certain are very safe for human beings: alcohol and aspirin.”

I am not sure I understand. We know alcohol isn’t safe, let alone very safe, in any quantity. So immediately this seems contradictory?

That appears to have been the point.
Anecdata: even a few days of low-dose aspirin causes me terrible GI pain and exacerbates an otherwise 30-year dormant ulcer. I would love to be able to take it, but I can't tolerate it at all.
Have you tried the "enteric coated" aspirin? The coating is supposed to resist dissolving until the pill is well past your stomach.
What was your dosage? Tried dissolving in water?
Aspirin's bleeding risk is very well studied. You can find many papers showing between around 30% increase in the brain, and around 60% for the gut.
Alcohol has a bunch of recent studies showing that no amount is good, and as little as two drinks per week yield measurable negative impacts.
what if I do all the other things that go along with drinking for health, like speak Italian or French while I drink?
First search hit:

  They report preventable deaths caused by alcohol is higher in France than anywhere else in Europe.
Speaking French doesn't appear to help you. Maybe Italian is better.
Sounds like bs if you look at Russian numbers.
meh, I just care about all-cause mortality. I'll accept some preventable death risk if it's outweighed by non-preventable death risk improvement.

I think the French hit a good sweet spot between high alcohol consumption and high life expectancy. Quite a male-female disparity though. Maybe Irish do better at 0.2years reduction for an extra 0.4l of alcohol per year

https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

https://en.wikipedia.org/wiki/List_of_countries_by_alcohol_c...

Those are both drugs with very significant risks
Also addressed in TFA, it turns out. GI symptoms are pretty mild in the universe of cancer drug side effects, and the aspirin slows metastatic cancer spread considerably, so seems like a no brainer.
It isn't a cancer drug, so that isn't a fair comparison. GI symptoms from eating more broccoli and not ever drinking are also pretty mild compared to cancer drugs. Aspirin appears to be a preventative according to some initial research. National cancer institute says even the most at-risk age group (age 60+) is still only has cancer rates of around 1 in 100. How long are you going to take low dose aspirin?

Are GI symptoms mild if you take low dose aspirin on a daily basis for 30 years? 40? Longer even? All to reduce your odds of getting cancer from 1 in 100 to 1 in 120 at the latest stage of your life. The gains are marginal in younger stages of your life where cancer rates are much lower.

Don't get me wrong, if this is validated it's a very interesting result. A mechanism of action could be potentially groundbreaking. It doesn't mean start taking aspirin every day for the rest of your life at age 38 just to be on the safe side, however.

It is also worth considering that this is purely an association at this point. It is possible that some of this effect is because cardiovascular disease, the primary reason for taking low dose aspirin, tends to kill people before the odds of getting cancer have time to really flex their muscles. We might assume that ethical researchers without perverse incentives working within a system primarily concerned with scientific truth would have ruled out that possibility... but then we would be idealists who are ignorant of how the world works. Or any other number of reasons why this might turn out to be a big old pot of nothing to get excited about.

Long term low-dose aspirin regimes are well studied and common (for cardiovascular protection). This isn't some oddball thing the study is suggesting people do; the reason they were able to survey over 1MM pts is that so many people are already doing this.

Meanwhile --- and I say this as a stalwart enjoyer and advocate of crucifers of all kinds --- broccoli is simply not associated with dramatic suppression of cancer metastases.

1 in 100 cancer odds is off by at least an order of magnitude. From the studies I've read, lifetime risk of cancer is about 1 in 3.

This should be used as an icebreaker in college. "Look to your left, then look to your right. One of you will die of cancer."

The study population was cancer patients, so low dose aspirin was studied as a cancer drug. It doesn't say what the effect would be in the general population. Don't take aspirin just because it might help cancer patients, but if you've had cancer, consult with your oncologist.
> It doesn't mean start taking aspirin every day for the rest of your life at age 38 just to be on the safe side, however.

Younger people than that do get cancer and die from it. If it arrests tumour growth and even sometimes causes reduction and one is at risk, resisting aspirin treatment out of cargo cult common sense is a bad idea.

Only for some people, I've taken low dose aspirin (family history of heart attack) for 20 years now without any side effects (except perhaps not dying from heart attacks)
I'm annoyed that the FDA has kept cox-2 selective inhibitors restricted when the data I've seen shows they have lower GI risks and similar cardiovascular risks as other NSAIDs.
because the FDA are sticks-in-the-mud who get blowback when they approve something bad and but barely hear anything if they delay or restrict something good. there was also a to-do about celecoxib potentially increasing risk of heart attacks, plus the off-label marketing thing that led to the largest (at the time) settlement of that sort in history.

the process was also crazy complicated until some new 2020 legislation. the FDA published monographs saying things like "you can make a pain reliever with the following active ingredients and in the following forms." for example, no changes to the monographs on cough and cold medicines were made between 1987 and 2020. the new regime is of course a new mess to figure out, and consumers won't necessarily know the difference between a selective versus nonselective cox inhibitor. so you spend all this money and maybe inertia just keeps people buying ibuprofen and naproxen because it's what they know. and marketing something explicitly as "safer than ibuprofen" would be a massive hurdle to get cleared.

you can find all the FDA's monographs here, where it lists specific ingredients, concentrations, labeling, and testing procedures. https://dps.fda.gov/omuf/monographsearch

Oh i remember reading all of these studies 10 years ago and thinking they had so much potential relative to the small but significant risk in MI. I hope they are reevaluated at some point.
I've heard it's good to take with milk.
Common misconception, it's actually best to take with alcoholic beverages containing dairy. So like a white Russian.

(I'm obviously joking, this is your friendly reminder not to take medical advice from randos on the internet, especially when their source is "I've heard").

but now you have trained bing, so millions will die
GP is a bad user. Bing is a good Bing.
I did hear something from a stranger about hearing somethings on internet from strangers so this tracks, it would seem. I will comply fully henceforth!
But they told me to aim high!