New Findings Change Aspirin-a-Day Guidelines

Our concierge family practice doctors in Jupiter understand the temptation to pop a pill—whether a prescription medication or a supplement—to stay healthy, instead of following more difficult suggestions regarding exercise and diet.

And to be sure, the long-standing belief that taking a daily low-dose aspirin can prevent heart attacks has some scientific basis for those who’ve already suffered a heart attack. In addition, some earlier research did seem to support daily aspirin use for reducing the risk of numerous cancers as well as Alzheimer’s disease.

Latest findings

But the good thing about science in general and medical research in particular is that researchers are constantly reviewing and refining established knowledge. In the case of the aspirin-a-day approach, for example, several new studies in the last year have challenged the practice of taking a low-dose (81 mg.) aspirin to prevent cardiovascular disease (CVD). And this month the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines recommending against the use of daily low-dose aspirin, based on these studies.

One study published last month in the Journal of the American Medical Association (JAMA), for example, found that people without heart trouble who took a daily dose of aspirin had a lower risk of heart attack, stroke, and death. These benefits, however, were canceled out by the increased risk of bleeding in the intestinal tract or the brain, which can often be deadly.

Researchers in that study performed a meta-analysis of 13 studies that included 164,225 participants, none of whom had CVD when the studies began.

“For every 256 patients treated with aspirin for five years, one heart attack, stroke or death from cardiovascular disease would be prevented,” Dr. Sean Zheng, lead author of the study and and academic clinical fellow in cardiology at King’s College Hospital in London, told CNN. “On the other hand, for every 210 patients treated with an aspirin over the same period, one would have a serious bleeding event.”

“This calls into question the net benefit of taking aspirin, and whether people who have not previously had cardiovascular disease should take aspirin,” Zheng said.

Another study published last fall in the New England Journal of Medicine (NEJM) reported similar results, even finding that older patients experienced no health benefits at all from daily aspirin use. These and other recent studies are what led to this month’s revised recommendations from the AHA/ACC.

“We knew there would be an increased risk of bleeding with aspirin, because there has always been,” recommendations co-author Dr. Anne Murray told NBC News. “But not only did it not decrease risk of disability or death, it did not decrease the risk of heart attack and stroke, and there was an increase in the rate of death.” Murray is also a geriatrician and epidemiologist at the Hennepin Healthcare Research Institute and the University of Minnesota, Minneapolis.

In their statement, the AHA/ACC advised against taking a preventive aspirin a day, saying it may actually cause more harm than good.

“We’re talking about healthy people who don’t have known heart disease or stroke, who might have been considering or [are] already taking an aspirin to prevent that heart attack or stroke in the first place,” said Dr. Erin Michos, another of the authors of the new AHA/ACC guidelines.

The AHA stressed that the new recommendations do not apply to people who have already had a heart attack or stroke, or who have undergone such procedures as receiving a coronary artery stent or bypass surgery. But for the elderly (people over 70) and those with a high risk of internal bleeding, the AHA cautioned that “aspirin may do more harm than good, but there are no absolutes, so these decisions need to be tailored to individuals.”

Another co-author of the revised recommendations suggested that doctors might advise their patients who have a strong family history of heart disease to take a daily aspirin. This could also apply to those whose tests reveal considerable plaque build-up in their arteries. But for those with a low or moderate risk, lifestyle changes could have a more salient effect.

“Eat a heart-healthy diet, get regular physical activity, control blood pressure and control cholesterol,” Michos said. “If [people] need a statin, take it. Those are much more important when compared to recommending aspirin.”

As with so many other over-the-counter remedies, we always recommend you check with us before taking them. Each person is different and their needs and sensitivities are also different. We can help determine the best course for you.

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Another Weapon In the War Against Flu

The flu killed 80,000 Americans last year and was responsible for the hospitalization of another 960,000. Then there are those whose symptoms didn’t reach such drastic levels, but who spent many miserable days suffering the effects.

So our concierge family practice doctors in Jupiter, FL, at MD 2.0, were pleased to note that last month the U.S. Food and Drug Administration (FDA) for the first time in 20 years approved a new drug designed to help alleviate the symptoms of the flu. Xofluza (baloxavir marboxil) is a single-dose oral prescription drug intended for patients 12 years of age and older who have been experiencing symptoms for no more than 48 hours.

The difference in Xofluza

Just in time for flu season, Xofluza joins other antiviral treatments currently available, including Tamiflu and Relenza. The difference between Xofluza and other antiviral drugs is in the way it’s administered. It is the only antiviral that can be taken as a single dose to be effective. Others must be taken over several days or inhaled as a powder. While Xofluza did not work any better in clinical trials than its competitors already on the market, it’s the convenience of the single oral dose that sets it apart. The most common reported side effects of Xofluza were diarrhea and bronchitis.

“With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical,” FDA Commissioner Scott Gottlieb, M.D., said in a statement. “This novel drug provides an important, additional treatment option.” Xofluza was expected to be available “within the next several weeks.”

“Xofluza is unique in that it acts to inhibit replication of the flu virus in the first place, at a step much earlier than the current medications available . . . which only block release of virus that has already been produced from a host cell,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City told CBS News.

Dr. Debra Birnkrant, director of the Division of Antiviral Products in the FDA’s Center for Drug Evaluation and Research, hailed the addition of Xofluza to the arsenal of weapons against the flu.

“Having more treatment options that work in different ways to attack the virus is important because flu viruses can become resistant to antiviral drugs,” she said on the FDA’s website.

You still need a flu shot

While the antiviral medications, including Xofluza, can reduce symptoms and help them recede faster than a placebo, they are not an instant curative. Nor do they prevent the flu or prevent you passing it on to others. If you contract the flu, you will still have to endure several days of misery, and you will still be contagious while exhibiting symptoms. So it’s best not to catch it all all.

“[S]easonal flu vaccine is one of the most effective and safest ways to protect yourself, your family, and your community from the flu and serious flu-related complications,” Gottlieb said. “Yearly vaccination is the primary means of preventing and controlling flu outbreaks.”

We concur. Last month the Centers for Disease Control and Prevention (CDC) released a report showing that less than 40 percent of adults in the U.S. received flu shots last winter, the lowest rate in seven years and probably one reason that last season’s flu outbreak was the deadliest since the 1970s. Of the 183 children who died last year, 80 percent had not been vaccinated.

You can help boost your immunity by exercising, eating healthfully, washing your hands often, and getting enough sleep, but there’s still no better way to prevent the flu, or lessening symptoms and its complications, than by receiving a flu shot.

“Yearly vaccination is the primary means of preventing and controlling flu outbreaks,” said Gottlieb.

And if you or your children do come down with the flu, contact us immediately. The sooner you receive Xofluza or other antiviral medications, the better they will work.

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