Buffing the Halo
I would be lying if I said I didn’t enjoy highly questionable statements made by “experts.”
For instance, a recent American Heart Association (AHA) press release carried a quote from a researcher who’s also a doctor. In commenting on a study that found non-steroidal anti-inflammatory drugs (NSAIDs) to raise the risk of premature death, he stated: “There is no doubt about the beneficial effects of aspirin among patients after heart attackand the scientific evidence is undeniable.”
No doubt? Maybe he meant to say “plenty of doubt.” But I doubt it.
Half in the bag
I’ll back up a little bit.
The study mentioned above comes from a university hospital in Copenhagen, Denmark. Researchers evaluated medical records of more than 58,000 heart attack patients. The records were matched against prescriptions for COX-2 inhibitors and NSAIDs that were filled by the patients after their heart attacks. (The seven-year study period ended in 2002, so Vioxx was among the COX-2 inhibitors used; long before it was taken off the market in 2004.)
After assessing the risk of a second heart attack or death by any cause, researchers found that patients taking these medications had a “strikingly higher risk of death” within the study period compared to heart attack patients who didn’t use the drugs. Furthermore, higher doses of the drugs were associated with an even higher risk of death.
But there was a curveball in the results: Use of COX-2 inhibitors or NSAIDs didn’t increase the risk of a second heart attack. According to the AHA press release (the study hasn’t been published yet), researchers are now examining death certificates to assess the different causes of death.
Hmmwouldn’t that have been the obvious thing to do beforethey started reporting on the results?
Besides the fact that other studies have shown that Vioxx and (to a lesser extent) other COX-2 inhibitors increase heart attack risk, there was yet another curveball in the study: Aspirin intake wasn’t assessed.
Aspirin is probably the most widely used NSAID. But according to Gunnar H. Gislason, M.D., the lead author of the study, the absence of aspirin data is not a factor. Why? Because according to Dr. Gislason (let’s look at his quote again): “There is no doubt about the beneficial effects of aspirin among patients after heart attackand the scientific evidence is undeniable.”
Not so fast, Doc.
In the e-Alert “Double-Edged Wonder” (7/14/04), I looked at a UK study that examined the use of aspirin and prescription blood thinner (warfarin) in about 280 patients who had suffered either heart attack or stroke.
After an average follow up period of more than two years, neither the aspirin nor the warfarin provided any greater protection against death, nonfatal stroke, or nonfatal heart attacks than a placebo. Subjects who received aspirin therapy, however, were nearly twice as likelyto suffer a heart attack or stroke as were those who took warfarin or placebo. Gastrointestinal problems were also elevated in the aspirin group.
In an interview with Reuters Health, the lead researcher of the study, Dr. John G. F. Cleland, stated that any theoretical benefit of using aspirin after a heart attack “is outweighed by real evidence of harm.”
Freshly buffed halo
Last week a new aspirin study was published in the Journal of the American Medical Association. The study found that women apparently receive modest stroke protection from aspirin therapy, but little cardiovascular protection. The opposite is true for men.
Of course, the media reports about this research treated aspirin’s saintly status as a given, furthering the 20th Century myth that this drug somehow works miracles with no side effects.
Tell your family and friends: Aspirin is a drug. And while it may have its place, it should be used just as you would use any drug: with caution.
“Most NSAIDs Raise Risk Of Death After Heart Attack” American Heart Association, 11/14/05, sciencedaily.com
“The Warfarin/Aspirin Study in Heart Failure (WASH): a Randomized Trial Comparing Antithrombotic Strategies for Patients with Heart Failure” American Heart Journal, Vol. 148, No. 1, July 2004, ncbi.nlm.nih.gov