Long-term aspirin and death risk for women: new study
Women who took low to moderate daily doses of aspirin had a reduced death rate, especially from heart disease, according to decades-long research. The research, based on data from a major trial that has tracked almost 80,000 women since 1976, found women who reported using aspirin on a regular basis had a 25% lower risk of death from any cause than women who didn't take the drug.
The risk of death from cardiovascular disease was 38% lower for aspirin users, and there was also a 12% reduction in cancer deaths that... took effect after a decade of aspirin use, the researchers found in their report based on the Nurses' Health Study.
The results were published in the March 26 issue of the Archives of Internal Medicine.
However, an accompanying editorial in the journal cautioned that the results were open to debate and far from definitive.
The dissenting editorial, by Dr John A. Baron of Dartmouth Medical School, was based in large part on results of a different trial, the Women's Health Study, which followed almost 40,000 women for 11 years and found no reduction in overall deaths or cardiovascular mortality associated with aspirin therapy.
Therefore, Baron said, the new findings "cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women."
"This is a complicated issue," said Dr Andrew T. Chan, an assistant professor of medicine at the Harvard Medical School, and lead author of the new report. "We understand that aspirin has potential health benefits, but who would aspirin therapy be appropriate for?" There are "areas of disagreement that need further study" before that question can be answered, Chan said. But there is information from the two large studies and other trials that can help guide women and their physicians, he said.
For starters, some studies suggest aspirin has benefits for older women and those who have cardiovascular risk factors such as high blood pressure, diabetes, high cholesterol and obesity, Chan said. "Our study and the Women's Heath Study do suggest that there is a potential role of aspirin for women who have subclinical cardiovascular disease," he added.
That statement meshes with prevention guidelines issued in 2004 by the American Heart Association. The guidelines recommend aspirin for women at high risk of heart disease or who already have cardiovascular disease, but they don't apply to women at low risk for the disease. For intermediate-risk women, aspirin can be considered if blood pressure is under control and the benefits are believed to outweigh risks, such as gastrointestinal bleeding.
But the decision to take aspirin, or any other medication, should not be made by an individual alone, Chan said. "I tell women that, at this point, the decision calls for consultation with a doctor," he said. "Aspirin does have side effects, so it is something that has to be individualized. It would be very naive to recommend that treatment for all women across the board."
The new study included information on 29,000 participants in the Nurses' Health study who took between one and 14 standard 325mg aspirin tablets a week and 5002 women who took more than 14 tablets weekly.
The reduction in cancer risk that became evident after 10 years was an intriguing finding, Chan said. The Women's Health Study found no such reduction over a decade, he said. "One important message is that the study suggests the mechanisms at play for cardiovascular disease and cancer are potentially common," Chan said. "This provides further grounds for research into these mechanisms."
Dr Jeffrey Berger, a cardiology fellow at Duke University who has done related research, said the new report describes "another very large study that tells us individuals who take aspirin live longer. You can't argue with that. We can't prove cause-and-effect, but we can say that when you take aspirin, there is a reduction in overall deaths."
It's important to remember that aspirin has benefits for both men and women, Berger added. "How it benefits men, how it benefits women, that is an important issue at this time," he said.
And anyone who is thinking about daily aspirin "should really talk with doctors about the benefits and risks," Berger said.
Copyright (c) 2007 CMPMedica (NZ) Ltd. All rights reserved.
Read More..
The risk of death from cardiovascular disease was 38% lower for aspirin users, and there was also a 12% reduction in cancer deaths that... took effect after a decade of aspirin use, the researchers found in their report based on the Nurses' Health Study.
The results were published in the March 26 issue of the Archives of Internal Medicine.
However, an accompanying editorial in the journal cautioned that the results were open to debate and far from definitive.
The dissenting editorial, by Dr John A. Baron of Dartmouth Medical School, was based in large part on results of a different trial, the Women's Health Study, which followed almost 40,000 women for 11 years and found no reduction in overall deaths or cardiovascular mortality associated with aspirin therapy.
Therefore, Baron said, the new findings "cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women."
"This is a complicated issue," said Dr Andrew T. Chan, an assistant professor of medicine at the Harvard Medical School, and lead author of the new report. "We understand that aspirin has potential health benefits, but who would aspirin therapy be appropriate for?" There are "areas of disagreement that need further study" before that question can be answered, Chan said. But there is information from the two large studies and other trials that can help guide women and their physicians, he said.
For starters, some studies suggest aspirin has benefits for older women and those who have cardiovascular risk factors such as high blood pressure, diabetes, high cholesterol and obesity, Chan said. "Our study and the Women's Heath Study do suggest that there is a potential role of aspirin for women who have subclinical cardiovascular disease," he added.
That statement meshes with prevention guidelines issued in 2004 by the American Heart Association. The guidelines recommend aspirin for women at high risk of heart disease or who already have cardiovascular disease, but they don't apply to women at low risk for the disease. For intermediate-risk women, aspirin can be considered if blood pressure is under control and the benefits are believed to outweigh risks, such as gastrointestinal bleeding.
But the decision to take aspirin, or any other medication, should not be made by an individual alone, Chan said. "I tell women that, at this point, the decision calls for consultation with a doctor," he said. "Aspirin does have side effects, so it is something that has to be individualized. It would be very naive to recommend that treatment for all women across the board."
The new study included information on 29,000 participants in the Nurses' Health study who took between one and 14 standard 325mg aspirin tablets a week and 5002 women who took more than 14 tablets weekly.
The reduction in cancer risk that became evident after 10 years was an intriguing finding, Chan said. The Women's Health Study found no such reduction over a decade, he said. "One important message is that the study suggests the mechanisms at play for cardiovascular disease and cancer are potentially common," Chan said. "This provides further grounds for research into these mechanisms."
Dr Jeffrey Berger, a cardiology fellow at Duke University who has done related research, said the new report describes "another very large study that tells us individuals who take aspirin live longer. You can't argue with that. We can't prove cause-and-effect, but we can say that when you take aspirin, there is a reduction in overall deaths."
It's important to remember that aspirin has benefits for both men and women, Berger added. "How it benefits men, how it benefits women, that is an important issue at this time," he said.
And anyone who is thinking about daily aspirin "should really talk with doctors about the benefits and risks," Berger said.
Copyright (c) 2007 CMPMedica (NZ) Ltd. All rights reserved.
Pregnancy mistakes even smart women make
With the wealth of medical knowledge that's out there for everyone to access, it's a wonder that people still engage in patently non-healthy behavior. Millions of individuals still smoke cigarettes, for instance, despite overwhelming evidence against their use. Even the more prudent make the occasional health-care "mistake"--over-flossing, for instance (dentists recommend doing so only once every other day), or thinking that only children need vaccination (adults do, too).
Part of the problem is that there is simply too much information coming in--and too fast!--to be absorbed. Many times media reports are... either vague or ambiguous at best or, at worst, clash glaringly with conventional medical knowledge.
For most laymen, interpreting medical jargon, research scientists and anyone else who sends out health-related signals is like trying to figure out a Rubik's cube. A pregnant woman cannot escape the confusion and is, perhaps because of situational anxieties, more prone to misinformation than ordinary individuals, especially when every woman in her life--mother, grandmother, sister, aunt, cousin, in-law and friend--is anxious to dispense advice on the healthy, "proper" way of going through pregnancy and labor.
Our advice? Talk to your obstetrician. No issue should be too simple or too complicated to discuss. Ask her all your questions and explore with her all your concerns. You and your doctor are a team. Your goal is to make sure you deliver a healthy baby. The only way that can happen is if you work together and communicate regularly.
Pregnancy no-no's
For starters, we've listed a few choices and decisions we discourage pregnant women from taking: A healthy pregnancy they surely will not make. Check to see if any of the items apply to you and then go see your doctor so you can both figure out what to do about them.
1. Taking preconception folic acid for granted. Folic acid is essential for the healthy development of baby's nervous system. This occurs during the first 45 days of life, at a time when a woman doesn't even know yet that she's pregnant. If you're planning on having a baby, be sure to take a multivitamin supplement containing folic acid once you begin trying to conceive.
2. Stopping medications for pre-existing diseases. A lot of women think that all prescription drugs are teratogenic (can cause birth deformities), and the reflex is to stop taking them once the stick turns blue. This decision often does more harm than good, especially for women with pre-existing diabetes, seizure disorders or psychiatric illnesses, which have to be kept in check. The best thing to do is to ask the doctor for advice on continuing versus stopping the medication.
3. Thinking that morning sickness is always normal. Nausea and vomiting in pregnancy, which occur in 70 percent to 85 percent of women, are traditional signs of a healthy pregnancy. Severe and persistent vomiting unrelated to other causes and leading to weight loss of at least 5 percent of pre-pregnancy weight, however, is not. It strongly suggests hyperemesis gravidarum, a condition that can lead to dehydration, vitamin and mineral deficiencies, and a low birth weight. The truth is that pregnant women don't have to "grin and bear it." Many medications can help alleviate morning sickness.
4. Not screening for chromosomal abnormalities. A lot of women think that having children with chromosomal abnormalities (e.g., Down's syndrome) occurs only in pregnant women over 45, who carry a one-in-30 risk of having a Down's baby. The truth is, these abnormalities occur sporadically and, while age-related, may still strike the offspring of young women. Screening is widely available, and all women should be aware of this option.
5. Eating for two. Average weight gain during pregnancy should only be about 25 pounds. Putting on a lot more weight will increase your chances of hypertension, gestational diabetes and having a big baby (and a more difficult delivery, of course!).
6. Decreasing activity. Engaging in mild to moderate exercise is still best. It keeps you fit and prepares you for the rigors of delivery. Ask your doctor to prescribe an exercise regimen for you.
7. Suffering through low-back pain. The condition called sacroiliitis is very common in pregnancy due to the laxity of the lower back ligaments and postural changes. Physical therapy and simple exercises can help relieve sacroiliitis.
8. Abstaining from sex. Except in cases of preterm labor (or a history of preterm deliveries) and bleeding due to a diagnosed placental abnormality, it is safe to engage in sexual activity--as long as it's not too acrobatic--at all stages of pregnancy.
9. Missing the blood work. Asian women are particularly predisposed to gestational diabetes, so it's important to be screened for this condition.
10. Shunning pain relief, especially epidural anesthesia, during labor. Evidence has shown that being given an epidural doesn't necessarily lengthen labor, as was previously thought.
11. Thinking that Lamaze will work miracles. The Lamaze technique is not guaranteed to work for everyone, so don't count on pain-free labor.
12. Asking the universe for twins. Multiple pregnancies, compared to ordinary single-baby pregnancies, bring a lot more complications.
13. Asking for a C-section. A C-section will involve more difficult, more painful recuperation than vaginal delivery, believe it or not.
14. Asking for perineal repair after delivery to "make the vagina virginal again." Perineal repairs and episiotomies may cause more blood loss during delivery. Discuss your options with your obstetrician.
15. Not taking prenatal vitamins and iron. Iron is the only mineral that must be supplemented in pregnancy, but some women stop taking their iron supplement when they begin to experience side effects like nausea or constipation. A simple solution to the problem is to take the iron pill at bedtime, and increase the fiber in one's diet or take stool softeners.
16. Fretting about breast-feeding. While breast-feeding is best for babies, a woman has the right to decide whether to breast-feed or not. She should not feel guilty if she cannot breast-feed for any reason or produce milk immediately after delivery. It's perfectly normal not to have milk until the third to the fifth day, so giving a temporary bottle at this time will not cause nipple confusion
Read More..
Part of the problem is that there is simply too much information coming in--and too fast!--to be absorbed. Many times media reports are... either vague or ambiguous at best or, at worst, clash glaringly with conventional medical knowledge.
For most laymen, interpreting medical jargon, research scientists and anyone else who sends out health-related signals is like trying to figure out a Rubik's cube. A pregnant woman cannot escape the confusion and is, perhaps because of situational anxieties, more prone to misinformation than ordinary individuals, especially when every woman in her life--mother, grandmother, sister, aunt, cousin, in-law and friend--is anxious to dispense advice on the healthy, "proper" way of going through pregnancy and labor.
Our advice? Talk to your obstetrician. No issue should be too simple or too complicated to discuss. Ask her all your questions and explore with her all your concerns. You and your doctor are a team. Your goal is to make sure you deliver a healthy baby. The only way that can happen is if you work together and communicate regularly.
Pregnancy no-no's
For starters, we've listed a few choices and decisions we discourage pregnant women from taking: A healthy pregnancy they surely will not make. Check to see if any of the items apply to you and then go see your doctor so you can both figure out what to do about them.
1. Taking preconception folic acid for granted. Folic acid is essential for the healthy development of baby's nervous system. This occurs during the first 45 days of life, at a time when a woman doesn't even know yet that she's pregnant. If you're planning on having a baby, be sure to take a multivitamin supplement containing folic acid once you begin trying to conceive.
2. Stopping medications for pre-existing diseases. A lot of women think that all prescription drugs are teratogenic (can cause birth deformities), and the reflex is to stop taking them once the stick turns blue. This decision often does more harm than good, especially for women with pre-existing diabetes, seizure disorders or psychiatric illnesses, which have to be kept in check. The best thing to do is to ask the doctor for advice on continuing versus stopping the medication.
3. Thinking that morning sickness is always normal. Nausea and vomiting in pregnancy, which occur in 70 percent to 85 percent of women, are traditional signs of a healthy pregnancy. Severe and persistent vomiting unrelated to other causes and leading to weight loss of at least 5 percent of pre-pregnancy weight, however, is not. It strongly suggests hyperemesis gravidarum, a condition that can lead to dehydration, vitamin and mineral deficiencies, and a low birth weight. The truth is that pregnant women don't have to "grin and bear it." Many medications can help alleviate morning sickness.
4. Not screening for chromosomal abnormalities. A lot of women think that having children with chromosomal abnormalities (e.g., Down's syndrome) occurs only in pregnant women over 45, who carry a one-in-30 risk of having a Down's baby. The truth is, these abnormalities occur sporadically and, while age-related, may still strike the offspring of young women. Screening is widely available, and all women should be aware of this option.
5. Eating for two. Average weight gain during pregnancy should only be about 25 pounds. Putting on a lot more weight will increase your chances of hypertension, gestational diabetes and having a big baby (and a more difficult delivery, of course!).
6. Decreasing activity. Engaging in mild to moderate exercise is still best. It keeps you fit and prepares you for the rigors of delivery. Ask your doctor to prescribe an exercise regimen for you.
7. Suffering through low-back pain. The condition called sacroiliitis is very common in pregnancy due to the laxity of the lower back ligaments and postural changes. Physical therapy and simple exercises can help relieve sacroiliitis.
8. Abstaining from sex. Except in cases of preterm labor (or a history of preterm deliveries) and bleeding due to a diagnosed placental abnormality, it is safe to engage in sexual activity--as long as it's not too acrobatic--at all stages of pregnancy.
9. Missing the blood work. Asian women are particularly predisposed to gestational diabetes, so it's important to be screened for this condition.
10. Shunning pain relief, especially epidural anesthesia, during labor. Evidence has shown that being given an epidural doesn't necessarily lengthen labor, as was previously thought.
11. Thinking that Lamaze will work miracles. The Lamaze technique is not guaranteed to work for everyone, so don't count on pain-free labor.
12. Asking the universe for twins. Multiple pregnancies, compared to ordinary single-baby pregnancies, bring a lot more complications.
13. Asking for a C-section. A C-section will involve more difficult, more painful recuperation than vaginal delivery, believe it or not.
14. Asking for perineal repair after delivery to "make the vagina virginal again." Perineal repairs and episiotomies may cause more blood loss during delivery. Discuss your options with your obstetrician.
15. Not taking prenatal vitamins and iron. Iron is the only mineral that must be supplemented in pregnancy, but some women stop taking their iron supplement when they begin to experience side effects like nausea or constipation. A simple solution to the problem is to take the iron pill at bedtime, and increase the fiber in one's diet or take stool softeners.
16. Fretting about breast-feeding. While breast-feeding is best for babies, a woman has the right to decide whether to breast-feed or not. She should not feel guilty if she cannot breast-feed for any reason or produce milk immediately after delivery. It's perfectly normal not to have milk until the third to the fifth day, so giving a temporary bottle at this time will not cause nipple confusion
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