Health News Review

The following is a guest post submitted by Frederik Joelving, reporter and editor at Reuters Health. You can follow him on Twitter at @joelving.

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A couple of weeks ago, I received an email reminding me just how easy it is to stray from good evidence in the name of disease awareness. And this time it wasn’t a drugmaker that had gotten carried away. It was the CDC, which in a “Holiday tickler” about its Million Hearts campaign candidly urged Americans to take daily aspirin.

“The goal of this campaign is to have people send an e-card acknowledging the importance of owning their own health as a holiday gift to their family members,” a CDC press officer wrote to reporters.

“A personal acknowledgement of the ‘ABCs’ of good health is a great way for each person to take ownership of their own health,” he went on.

In case you didn’t get the email — or the e-card — ‘ABCs’ refer to Aspirin, Blood pressure control, Cholesterol control and Smoking cessation.

Specifically, the agency advised people to “Take a daily low-dose 81 mg to 160 mg aspirin (if you are medically able to take aspirin).”

Now wait a minute, I thought. Doctors still disagree about the value of taking the drug if you’re at average risk of heart disease and haven’t had a heart attack or stroke yet. Even if you have risk factors, you and your doctor need to weigh the pros and cons of going on permanent aspirin therapy.

“You should not start aspirin on your own,” the American Heart Association warns in bold letters.

The benefits of taking aspirin include heart attack prevention in men and stroke prevention in women — although for most healthy people, we are talking about extremely small reductions in risk (see http://www.reuters.com/article/2011/05/25/us-aspirin-study-idUSTRE74O7M220110525).

On the flipside, the drug comes with increased risks of bleeding ulcers and hemorrhagic strokes. What’s more, its overall effect on death rates, if any, is still up in the air.

“A blanket recommendation that everybody should take an aspirin is not a good idea” Dr. Michael LeFevre of the government-backed U.S. Preventive Services Task Force told Reuters Health last year. He added that the drug is probably overused by healthy people.

The task force currently advises that men age 45 to 79 take aspirin to stave off heart attacks as long as the benefit outweighs the risk of bleeding. For women age 55 to 79, the medication is recommended to prevent strokes, with the same caveat.

So I was surprised by the CDC’s blunt advice and asked the press officer if the agency is now broadly promoting aspirin to healthy people.

“We generally recommend this,” he told me, “but always include a caveat to include an ability to take aspirin as well as to consult your healthcare provider.”

The second caveat wasn’t in the original email, however. When pressed, the press officer referred me to Dr. Janet Wright, the executive director of the CDC’s Million Hearts Initiative.

In a phone interview, she readily acknowledged that the email was wrong and that she hadn’t seen it before it went out.

“Frankly, the aspirin thing can be so confusing to people,” Wright told me. “I’m so glad you were a filter before this got out.”

That’s debatable; presumably, I was just one of many journalists who got the CDC’s Million Hearts pitch.

Wright said the ABCs are in fact configured around secondary prevention, and added that “we should not advocate for a specific dosage.” But she wasn’t too worried about people starting on aspirin with little chance of benefiting from it.

“We have more of a problem with people who have been advised to take it and they don’t,” she said.

Still, the CDC was quick to correct the slip-up. Two days after its original email, the agency sent out a much more measured revision saying that, “If your doctor recommends aspirin, take it as prescribed.”

We all make mistakes. What matters is that we correct them.

Comments

Marilyn Mann posted on January 5, 2012 at 10:55 am

In my opinion, the USPSTF needs to update its recommendations with respect to aspirin for primary prevention. Low-dose aspirin is not recommended for most primary prevention patients. This is based on a meta-analysis published in The Lancet that showed little benefit for most primary prevention patients. Also, the meta-analysis showed that people who are at risk of cardiovascular disease also tend to be at risk for bleeding. There are individual patients for whom the benefits outweigh the risks, but that decision must be made on an individual basis.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60503-1/abstract

Also, if you are at high enough risk to justify taking medication to lower your risk of heart attack and stroke, aspirin would not be the first drug to start taking. It would make more sense to take a statin and to control your blood pressure (if applicable). The reason is that side effects from aspirin can be serious and life-threatening, while side effects from statins and blood pressure medications tend to be more of the nuisance variety. In addition, if you are already taking a statin the additional benefit of low dose aspirin, if any, is likely to be clinically insignificant, unless your baseline risk is very high.

I also note that the FDA has never approved an indication for primary prevention for aspirin.