Aspirin, in one form or another, has been part of the pharmacopoeia (GREAT word! and I love using it) for relieving suffering for literally thousands of years. Detractors quip that if aspirin came up for FDA approval today, it would never make it out of the gate since it can produce a host of side effects. Yet some of those self-same side effects also prove beneficial, and Rick and I discuss in PodMed this week and as seen on our YouTube, based on a study in NEJM.
Warfarin and Aspirin in Patients With Heart Failure and Sinus Rhythm followed over 2000 patients with heart failure for up to six years. Use of these medications in people with heart failure is thought to reduce the risk that they'll form blood clots, an observed phenomenon in those with the condition. People eligible for the study had a left ventricular ejection fraction, the putative test for heart failure, of 35% or less, but they did have a normal heart rhythm and were able to take the study medications. Outcome measures included strokes due to clot formation (ischemic stroke), bleeding inside the brain, or death from any cause. The good news is that there was no real difference between the two medications, with a few minor caveats: warfarin appeared to be better with regard to preventing ischemic stroke but worse with regard to major bleeding episodes. So why is this good news?
It's good news for the millions of people worldwide who currently have congestive heart failure, a number that is expected to rise dramatically, according to the World Health Organization. That in itself is partially a success story as people are living long enough to develop the condition and we're much better at managing it once they do. I would be remiss in not mentioning, however, that better management of cardiac risk factors in general and high blood pressure specifically would go a long way toward reducing this disease burden.
Managing congestive heart failure can require a number of medications, and when we examine aspirin versus warfarin we find a big disparity in price, with aspirin therapy costing very little. There's also the need to monitor blood levels when warfarin is used, most often requiring people to travel to a clinic and have their level measured. Warfarin is a really great example of Goldilocks medicine, where the level of the drug needs to be just right. That's not the case with aspirin. So aspirin works, it's much less expensive and doesn't require close monitoring. That's a win domestically and internationally, where the healthcare infrastructure often isn't as robust.
Other topics this week include two studies on mammography from Annals, addressing who is most likely to benefit from earlier screening, management of type 2 diabetes in adolescents in NEJM, and neonatal abstinence syndrome in newborns, in JAMA. Until next week, y'all live well.