Statins for practically everyone over 60?

I quote directly Fergus Walsh from his post ' A nation of pill poppers' from his column dated 12th February 2014:-

"A sensible step that will cut deaths and disability or a mistake that will medicalise millions? 

There are starkly opposing views of proposals from the health watchdog the National Institute for health and Clinical Excellence (NICE) to dramatically increase the numbers offered statins. 

They are already the most commonly prescribed medicines in the UK, which work by lowering the level of cholesterol in blood. Around seven million people are on the tablets which cost less than 10p a day. It is estimated they prevent around 7,000 deaths a year from heart attacks or strokes. Add to that the tens of thousands of people who are saved from disabling non-fatal attacks and you can see why health experts are keen on statins. 

A generation ago cardiovascular disease was common in early middle age. As a result of statins and treatments for reducing blood pressure, the condition has been delayed by around 20 years. 

That means two decades more of healthy life for millions of people. 

QRISK2
The current guidance from NICE says adults with at least a 20% chance of having a heart attack or stroke in the next 10 years should be offered statins. 

That is being lowered to a 10% chance of cardiovascular disease over 10 years. 

So how is the risk calculated? You can work out your individual risk by going online to the QRISK2 calculator. 

Input factors like your age, sex (men are at greater risk), ethnicity, blood pressure, Body Mass Index, family history, cholesterol level and so on. 

It also includes your postcode: heart disease is strongly linked to poverty and deprivation so that will alter your risk too (though clearly you would expect your doctor to take account of your background, rather than just relying on your address). 

My risk was well below the 10% trigger for statins. But any smug feeling was quickly despatched when I added a decade to my age. 

Once you hit your sixties you can virtually guarantee that your 10-year risk will place you in the statins category no matter how healthy you are. 

The effect of the proposals - which have gone out for consultation in England - would be to add millions to the numbers already on statins. 

Mark Baker, from NICE, who helped draw up the guidelines said: "You'd probably need to treat about 60 people with statins for 10 years to prevent one heart attack or stroke." 

That might not sound like it is worth it, but let's say you treated another six million people, that would prevent 100,000 heart attacks or strokes over a decade. 

Diet & exercise
Estimating the health benefits of statins is difficult, and those figures could be an over-estimate. But you can see that - taken over an entire adult population - the potential health benefits are enormous. 

So that's the argument in favour. Now the opposite view.
Putting people onto statins is akin to medicalising them for life. Rather than taking a pill to lower cholesterol, the same effect can be achieved through changing their diet and exercise levels.
Even small modifications to lifestyle - taking the stairs or getting off the bus one stop further from your destination - can make positive changes. 

Offering sedentary patients a quick fix may simply store up problems for later.
"It's a very bad idea", said Dr Aseem Malhotra a London cardiologist. "Eighty per cent of cardiovascular disease is due to lifestyle and NICE should be concentrating on that aspect rather than offering pills to millions." 

Dr Malhotra believes up to one in five people on statins will suffer side effects such as muscle pains, stomach pains or increased risk of diabetes. 

NICE says the figure is far lower and serious problems with statins are rare. NHS Choices says "statins are generally well tolerated and most people will not experience any side effects." It lists the range of possible adverse reactions. 

Ultimately it will be up to patients to decide, following consultation with their GP. One likely option for many will be to try statins and see whether they trigger any ill-effects. 

Statins are saving lives and preventing disability every day. So they are a powerful tool in promoting good health. But people will need to consider carefully before deciding to take a daily pill for decades to come."

reposted from: http://www.bbc.co.uk/news/health-26152492

crabsallover highlights, key points, comments / links.

BBC News - Should we worry about H7N9?

BBC News - Should we worry about H7N9?

Aspirin - risks and benefits

reposted from: http://www.bbc.co.uk/news/health-16479187 - Fergus Walsh, BBC reports

crabsallover highlights, key points, comments / links.

Listen to John Humphrys talk to Kausik Ray today about use of aspirin for healthy people and to Peter Rothwell last year. Further comment and related news stories.

Low dose aspirin is widely given to people with heart problems

More evidence has emerged of the conflicting benefits and risks of aspirin.

An analysis of nine medical trials involving over 100,000 people without a history of cardiovascular disease found that aspirin was more likely to do them harm than good.

Half the participants took aspirin, the other half a placebo; the studies lasted on average six years.

The researchers, writing in the Archives of Internal Medicine, found aspirin reduced the risk of cardiovascular disease by 10% but this was offset by a 30% increase in the risk of serious internal bleeds.

Professor Kausik Ray from St George's University of London told me: "Taking aspirin resulted in one fewer fatal heart attack for every 162 people over a six-year period. But among the same group you'd have about 2.5 extra serious bleeds, in the stomach or in the back of the brain, which could be fatal."

Whenever studies like this are published it immediately worries people who are taking the medication in question. So let's be clear. The strong advice - from these researchers and from other experts - is that those WITH a history of cardiovascular disease - such as heart attack or stroke - should continue with daily aspirin.

This is what's known as secondary prevention. And the evidence shows it works.

But aspirin is also prescribed as a primary prevention technique - for those without cardiovascular disease but who may be considered at risk of these conditions.

Indeed in 2005 guidelines were published which recommended low-dose daily aspirin for the over-50s who had a risk of cardiovascular disease - such as high blood pressure.

The guidelines are in the process of being updated and will be published later this year.

Dr Mike Knapton, associate medical director of the British Heart Foundation, welcomed the new research: "This is really helpful as it's been a bit of a murky area about who should receive aspirin. Now it's clear. If you have established heart disease you should take aspirin (unless there are contraindications) and if you don't fall into that category, then you should not."

Dr Knapton said simply being overweight, over 50, or with high blood pressure, were not enough on their own, despite them being risk factors. To fall into the group with cardiovascular disease you need to have symptoms such as angina (heart pain), and clogged arteries diagnosed following tests.

This research adds to other evidence that aspirin should only be used to ward off heart attacks and strokes in those with obvious cardiovascular disease.

This study does not settle another question - whether daily low dose aspirin can help prevent cancer over the long term. The researchers found no benefit over six years, but they admit that the effects of long-term use might not show up with regard to cancer until much later.

A major analysis of studies in 2010 (by Peter Rothwell) suggested daily low-dose aspirin could have a significant protective effect. Researchers at Oxford University followed up patients over two decades and found their overall risk of dying from cancer was cut by a fifth. That study suggested that the cancer prevention benefits outweighed the risks of internal bleeding.

Not for the first time, there is conflicting evidence on the effects of aspirin which - hopefully - future studies will resolve.

Update 11th January by Fergus Walsh

Thanks for your questions. I decided to take a daily low-dose aspirin following Prof Peter Rothwell's research last year based on the possible cancer reduction risk. I am continuing with that, but stress it is a personal decision - not a proposal to any readers of this blog. You can read my original blog post here.

First randomised trial specifically for aspirin in cancer

Prof. Sir John Burn

Crabsallover has followed the link between taking aspirin and reducation in Cancer since Peter Rothwell research results in 2010.

reposted from: http://www.nhs.uk/news/2011/10October/Pages/aspirin-cuts-lynch-syndrome-bowel-cancer-risk.aspx

crabsallover highlights, key points, comments / links.

Other studies over the past two decades have suggested Aspirin reduced cancer risk, but this was the first randomised control trial, specifically for aspirin in cancer, to prove it.


Aspirin cuts the risk of bowel cancer in people with inherited susceptibility to the disease,The Guardian has today reported. The newspaper said that a study of long-term aspirin use found it cut the risk of bowel cancer by more than 60% in these individuals.


Prof Sir John Burns (wikipedia) (won a Knighthood 2009) from Newcastle Uni (full list of John Burn publications) on the Today programme (2 min interview with Evan Davis) said 

 Burns mentioned very good research of Peter Rothwell looking at effect on aspirin on heart attack trials. Burns trial results:Out of 250 in trial group 23 cancers occurred in the placebo group but only 10 in the aspirin group.  63% fewer cancers!  In some way aspirin knocks off the cells that are going to be cancerous in a few years time. One theory is that inflammation is involved in cancer progression, aspirins inhibit prostaglandin production. John Burns personal theory is that it is driving programmed cell death (apoptosis). Plants make salicylates (cf aspirin is a salicylate derived from white willow bark) which drive programmed cell death and protects the bark from infection.

Prof Sir John Burn, from Newcastle University, said there were 30,000 adults in the UK with Lynch syndrome.

If all were given the treatment he said it would prevent 10,000 cancers over 30 years and he speculated that this could possibly prevent 1,000 deaths from the disease.

However, there would also be side effects.

"If we can prevent 10,000 cancers in return for 1,000 ulcers and 100 strokes, in most people's minds that's a good deal," he said.

"People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition."

One of the questions asked by the research into aspirin was whether healthy people with no family risks should take the drug.

The lower the risk of heart attack or cancer, the lower the benefit of taking aspirin, yet there are still potentially deadly side effects.

Sir John said that it was a "finely balanced argument" and that he decided the risks were worth it for him.

"I think where we're headed for is people that are in their 50s and 60s would look very seriously at adding a low dose aspirin to their daily routine because it's giving protection against cancer, heart attack and stroke.

"But if they do that they've got to have their eyes wide open. They will increase their risk of ulcers and gastrointestinal bleeds and very rarely they will have a stroke caused by the aspirin."

View John Burns interviewed by Dominic Hughes, BBC

Fergus Walsh, BBC Health Correspondent,  reports having taken aspirin daily for 11 months since the Peter Rothwell trial results.


Those on the John Burn trial took 600mg aspirin daily which is a much bigger dose than the 75 mg that many middle-aged people like me take to reduce their risk of cardiovascular disease. I wrote last year: "If I get an intestinal bleed in a few months time and am taken to hospital needing a blood transfusion, then it will be easy to argue that I got it wrong."

Well, so far so good.

John Burn also looked at other cancers eg womb and found a 50% reduction (Telegraph interview)

John Burn explains his trials and the biochemistry (8min 20s) of Aspirin mechanism to prevent cancers. It might be making faulty cells fall on their sword.

100,000 years ago we used to forage on plants that used salicylates to defend themselves. Now our diet is free of salicyates. Above paper in picture is

J. Burn, P. D. Chapman, D. T. Bishop and J. Mathers (1998). Diet and cancer prevention: the Concerted Action Polyp Prevention (CAPP) Studies. Proceedings of the Nutrition Society, 57 , pp 183-186 doi:10.1079/PNS19980030 (full pdf) 

Another 10 min video on mechanism of action of aspirin (technical)



another presentation by John Burn - trial results and biochem (5min 50s) "as in plants, salicylates initiate apoptosis (programmed cell death) among genetically abnormal stem cells that have yet to become cancer."

OUS827 library search: BOWEL CANCER PREVENTION: ASPIRIN INDUCES COX-2 INDEPENDENT ENDOTHELIAL CELL APOPTOSIS FACILITATING ANGIOGENESIS ARREST.
Detail Only AvailableBy: Johnson, A. S.; Arthur, H. M.; Burn, J.; Wilson, R. G.. Gut, Apr2004 Supplement 3, Vol. 53, pA21-A21, 
Conclusion: Both aspirin and celecoxib caused dose dependent reduction in cell viability, proliferation, and angiogenesis. Celecoxib produced these effects at levels in excess of normal serum levels when it is no longer COX-2 selective. Aspirin induces apoptosis via a COX-2 independent mechanism which may facilitate angiogenesis arrest and play a critical role in limiting tumour growth.

The Lancet Podcast of the 28th October 2011 press conference (20mins) - John Burn & Tim Bishop

taking 600mg / day aspirin gives 60% prevention of cancer - 75mg gives 25% prevention (13 mins) .. but a low dose will avoid a lot of ulcers.. (14 mins).. CaPP3 trials will give clue to best dose 75mg / 300mg / 600mg per day to offset cancer. CaPP3 website now launched!

 Press Release embargo 28th October 2011

The Lancet comments (subscription required)
'The long-term results of CAPP2 are also invaluable for the continued assessment of aspirin for prevention of sporadic colorectal cancer, which is not currently recommended mainly because of concerns about toxic effects and continuing uncertainty about dose and duration.10 With aspirin's well established vascular benefits and recent evidence of benefit for colorectal and other cancers in pooled cardiovascular randomised trials,11 Burn and colleagues' findings might at last tip the scales in favour of aspirin as the chemopreventive agent of choice for many individuals.

Does this long-term follow-up analysis allow a definitive conclusion, say for standard regulatory approval, about aspirin's ability to prevent colorectal cancer? In isolation, no, since the results of the primary analysis were not significant for the ITT (Intention-To-Treat) population. The data strongly support routine use of aspirin, however, for patients with Lynch syndrome as an adjunct to intensive cancer surveillance. As the first randomised trial of aspirin with colorectal cancer as the primary endpoint, CAPP2 also certainly moves us closer to a more definitive answer on aspirin's overall role in the prevention of colorectal cancer. Unfortunately, prohibitive logistics make a randomised trial of aspirin prevention with a colorectal cancer endpoint in a sporadic-risk population unlikely. Therefore, these results from CAPP2 and previous evidence arguably support more general recommendations to consider aspirin for prevention of colorectal cancer in the context of individualised risk-benefit assessments.

Cancer Research UK comment 'People with Lynch syndrome are about 10 times more likely that the general population to develop cancer, particularly of the bowel and womb, and often at a young age.'

Aspirin link to lower cancer death rates by BBCs Fergus Walsh

reposted from: http://www.bbc.co.uk/news/health-11933781

7 December 2010 Last updated at 07:49Help

A small dose of aspirin every day could significantly reduce the risk of dying from a range of common cancers, a study suggests.

Research at Oxford University and other centres found that it cut overall cancer deaths by at least a fifth.

Experts say the study, published in the Lancet, shows aspirin's benefits outweigh its associated risk of stomach and gut bleeding.

Fergus Walsh reports.

Read more

• Daily aspirin 'cuts cancer risk'

start lobbying for popping a 75-milligram aspirin a day to be included as official cancer prevention lifestyle advice

reposted from:  http://www.guardian.co.uk/science/2010/dec/12/aspirin-cancer-wonder-drug-lancet
crabsallover highlights in red

Health reporting has its own lexicon of hyperbole. We get a dizzying number of apparent breakthroughs, advances that will revolutionise patients' lives and, of course, offer the Holy Grail – cures – far beyond the evidence. One national newspaper proclaims a new cancer cure on its front page on many Mondays. Only last week a procedure billed as a "cure" for Type 2 diabetes turned out, sadly, to be nothing of the sort.

And, of course, there are "wonder drugs", a description given to many of the cancer medications that NHS organisations have declined to give to patients because the National Institute of Health and Clinical Excellence has decided the potential benefit gained is less than the huge expense involved.

But aspirin, the humblest of medicines, surely merits that accolade after last week's research reported in The Lancet showing that regular small doses reduce the risk of many cancers, some by up to 54%. (We already knew that aspirin helps prevent heart attacks and strokes.)

Unlike most research findings, these ones could, and arguably should, lead many people – in this case the over-45s – to alter their behaviour. Not for nothing did BBC medical correspondent Fergus Walsh, 49, write in his blog: "From now on I am going to take a daily low-dose aspirin. I intend to continue doing this for the next 25 years."

Peter Elwood, honorary professor of epidemiology at Cardiff University, was part of a team of researchers who in 1974 provided the first real proof of aspirin's efficacy. "It's a miracle drug because it's a simple molecule that is unique in attacking both the world's two major causes of death and disability, cardiovascular disease and cancer." While some drugs – statins, for example – are good at preventing heart attacks and strokes, and some at tackling cancer, only aspirin does both, stresses Elwood.

One other advantage is its cheapness, itself a result of it being out of patent in most countries. Drug giant Bayer, its creator, makes little from it anymore. Aspirin is now a generic drug – anyone can make it. So are there any others like that? Sadly not. "No other out-of-patent drug offers anywhere like the same benefit," says Elwood.

Aspirin is the commonest of wonder drugs, available at corner shops, supermarkets and petrol stations for as little as a penny a tablet. It is usually used for headaches, hangovers, a migraine, angina or rheumatic pain, or to stop the blood clotting and so thwart a heart attack, stroke or blood clot.

But last week's findings did not convince everyone. "I wouldn't call aspirin a wonder drug," says Sultan "Sid" Dajani, a pharmacist and spokesman for the Royal Pharmaceutical Society, the professional body for the UK's 45,000 pharmacists.

"To me, a wonder drug brings maximum benefit and minimal risk. Statins and antibiotics are wonder drugs, because both save lives, and some anti-cancer drugs, such as Tamoxifen, Herceptin and Avastin, because, while toxic, they give you hope and maybe a second chance. And when the genetic medicines in development become available – the 'magic bullet' drugs that can switch off genes that are precursors to things like diabetes, cancer and osteoporosis – if they work, they'll clearly be wonder drugs. But not aspirin."

For him, the risk of aspirin causing a stomach bleed is too great. Another drug, Clopidogrel, is more effective than aspirin and carries less risk, he says, but it's prescription-only and is far less available on the NHS because it costs much more than little white aspirin tablets. 

Elwood points out that while heart attacks and stroke have a 40% death rate, the worst outcome from excess consumption of aspirin is bleeding that will require a blood transfusion. "Compare the seriousness involved," he pleads.

After last week's breakthrough, some of the UK's most senior doctors will start lobbying for popping a 75-milligram aspirin a day to be included as official cancer prevention lifestyle advice, alongside not smoking, being physically active and eating healthily. Don't be surprised if they succeed.

• by Denis Campbell Health Correspondent
• The Observer, Sunday 12 December 2010

Fergus Walsh & Crabsallover talks to Peter Rothwell on aspirin & cancer prevention

reposted from: BBC interview by Fergus Walsh with Peter Rothwell





Full Transcription by crabsallover
0-0.26': Peter Rothwell: What we found was that in the trials where people had taken aspirin for 4, 5, 6 or 7 years on average, the risk of dying of cancer was reduced by about 25% during that time. The risk of dying from any cause was reduced by about 10%. What we then found was when we followed up these trials, the risk of dying of cancer over the next 20 years was reduced by about 20%.
0.27-0.31': Fergus Walsh: Why do you think aspirin has this protective effect?
0.32- 1.17': Peter Rothwell: There has been a lot of work over the years looking at tumour cells & animals with tumours which seems to suggest that aspirin affects the very early development of cancer cells. The fundamental  property of cancer cells is that they cease to respond to the normal signals that control growth and they grow uncontrollably. What aspirin does is that it reduces that rate of growth and seems to encourage cells to actually do the opposite. When they develop mutations, it encourages something called  apoptosis which is essentially suicide of the cell, the cell realises as it were that it has a problem and it self destructs. And there are mechanisms that leads cells to do that and aspirin appears to encourage those mechanisms.
1.18'- 1.36': Fergus Walsh: Lots of people take aspirin to guard against heart attack and stroke, if you add in the effect of cancer does this now mean that generally speaking it would be wise for middle aged people to take aspirin.
1.37'-2.17': Peter Rothwell: I think at the moment as you say, if you set aside the cancer results first of all the balance of risk and benefit is relatively fine in people who don't have risk factors for heart attacks and stroke. But if add on the cancer benefit it certainly pushes things in the direction of taking aspirin. If you have risk factors for heart attacks and strokes as well, the guidelines currently say you should probably think about taking aspirin anyway in your late forties or fifties particularly if you a man. And I think the cancer effects now certainly make that much more worthwhile. 
2.18'- 2.19': Fergus Walsh: But there are side affects and they can be serious?
2.20'-2.55': Peter Rothwell: They can. Their is a risk bleeding, of major bleeding of 1 per 1000 years for each patient as it were OR 1 per 1000 patient years OR 1 bleed per 1000 patients per year. Only a small proportion about 5% of those bleeds are fatal, so it's a small risk of death. When you put together all the risks, the risk of bleeding, the risk of heart attack and stroke and the effect on cancer, from the trials we looked at, taking aspirin reduces the risk  of premature death by about 10%.


Crabsallover Notes: in Peter Rothwell et al Lancet paper (pg 9) they say "Our analyses show that taking aspirin daily for 5–10 years would reduce all-cause mortality (including any fatal bleeds) during that time by about 10% (relative risk reduction)." 


In a personal communication  on 14th December, I emailed Peter Rothwell:-

'Dear Prof. Peter Rothwell,

In your December 2010 Lancet paper (pg 9) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62110-1/abstract you say  "Our analyses show that taking aspirin daily for 5–10 years would reduce all-cause mortality (including any fatal bleeds) during that time by about 10% (relative risk reduction)." 

Can you let me know how you arrived at the 10% all-cause mortality figure when taking aspirin daily? What were the individual % components of increased risk from serious gastrointestinal bleed, Gastric/duodenal ulcer, Occlusive & Haemorrhagic stroke (ref: Cuzick et al, Lancet Oncol 2009; 10: 501–07, table 2) and  reduced risk of cancer, heart attacks and other strokes?'

The same day Peter Rothwell replied "The estimate was based on the observed effect in the 8 RCTs. The Odds Ratio (OR) for all-cause mortality in the trials was 0.92 (see paper). Excluding patients who were randomised but stopped treatment before the first follow-up it was 0.88 in those trials with the data available. So "about 10%" seemed reasonable. However, we are in the process of doing a formal health economics paper, which I will send you in due course."

A small daily dose of aspirin - 75mg - substantially reduces death rates from a range of common cancers, a study suggests.

Research at Oxford University and other centres found that it cut overall cancer deaths by at least a fifth.

The study, published in the Lancet, covered some 25,000 patients, mostly from the UK.

Experts say the findings show aspirin's benefits often outweighed its associated risk of causing bleeding.

Aspirin is already known to cut the risk of heart attack and stroke among those at increased risk. But the protective effects against cardiovascular disease are thought to be small for healthy adults, and aspirin increases the risks of stomach and gut bleeds.

However, this latest research shows that when weighing up the risks and benefits of taking aspirin, experts should also consider its protective effect against cancer.

Those patients who were given aspirin had a 25% lower risk of death from cancer during the trial period and a 10% reduction in death from any cause compared to patients who were not given the drug.

Lasting protection

The treatment with aspirin lasted for between four and eight years, but long term-follow-up of around 12,500 patients showed the protective effect continued for 20 years in both men and women.

Continue reading the main story

“Start Quote

We encourage anyone interested in taking aspirin on a regular basis to talk to their GP first”

Ed YoungCancer Research UK

Lead researcher Professor Peter Rothwell said the findings might well underestimate the reduction in deaths that would result from longer-term treatment with aspirin.

The risk of cancer death was reduced by 20% over 20 years. For individual cancers the reduction was about 40% for bowel cancer, 30% for lung cancer, 10% for prostate cancer and 60% for oesophageal cancer.

The reductions in pancreas, stomach and brain cancers were difficult to quantify because of smaller numbers of deaths.

There was also not enough data to show an effect on breast or ovarian cancer and the authors suggest this is because there were not enough women in the trials. Large-scale studies investigating the effects on these cancers are under way.

Professor Rothwell said he was not urging healthy middle-aged adults to immediately start taking aspirin, but said the evidence on cancer "tips things towards it being well worth it". The benefit in cancer reduction were found from a low daily dose of 75mg.

Professor Rothwell said the annual risk of major internal bleeding was about 1 in 1,000 and aspirin roughly doubled that risk. But he said the danger of major bleeding was "very low" in middle age but increased dramatically after 75.

Continue reading the main story

“Start Quote

Aspirin should be thought of in the same context as lifestyle changes such as diet and exercise which can help to preserve health”

Professor Peter ElwoodCardiff University

• Aspirin: a personal choice for all

A sensible time to consider starting daily aspirin use would be between 45-50, continuing for around 25 years, he said.

Cancer Research UK described the results as "promising". But Ed Yong, head of health information and evidence, said: "We encourage anyone interested in taking aspirin on a regular basis to talk to their GP first."

Professor Peter Elwood, an epidemiologist from Cardiff University, who carried out some of the first studies into the effects of aspirin on health, said individuals should make up their own minds:

"Aspirin should be thought of in the same context as lifestyle changes such as diet and exercise which can help to preserve health."

Professor Elwood said taking aspirin at night and with calcium seemed to enhance its effects. He suggested taking it with a glass of milk as this could also reduce stomach irritation.

More on This Story

Related stories

• Aspirin: a personal decision 07 DECEMBER 2010, HEALTH
• Aspirin: What are pros and cons? 07 DECEMBER 2010, HEALTH
• Aspirin 'cuts bowel cancer cases' 21 OCTOBER 2010, HEALTH

Related Internet links

• The Lancet paper