Aspirin

[BertiWooster]

There was a recent report about the benefits of taking 75mg of aspirin on a daily basis .

However , i beleive that some experts are warning about the danger of taking aspirin - internal bleeding etc .

So what does one do - take it or not ?

[DEN53]

My Mum has taken 75mg of Aspirin for 25 years approx. She now has vascular dementia, which some say can be caused by a stroke. To our knowledge she has never suffered a stroke, but if she had, surely by taking the Aspirin, would this not have counter acted the affect of that?

[Sqad]

Den....I will let the prof answer......but that is a good question....the nub of aspirin taking.

If her dementia (stroke) was embolism, the aspirin MAY have helped, but if it was due to bleeding, then aspirin MAY have made it worse.

I am not clear what you mean by "vascular dementia"......!!

Was she well BEFORE she took the aspirin or did she take the aspirin after a cardiac "episode?"

[DEN53]

No cardiac episode, was just prescribed blood pressure meds, along with Statins and Aspirin by the GP - was never taken off them and I personally blame the Statins on her condition (but thats just my opinion).

[DEN53]

http://alzheimers.org...fo.php?documentID=161

[Sqad]

Den ;-)

[Sqad]

Den....right....a very wide description of a "generalised" problem.

Aspirin, statins, omega 3, 5 types of fruit....................confusing for the medics and even more for the public.

Take the medical advice from your doctor

[theprof]

Yes as Sqad says vascular dementias are a varied group of disorders rather then a specific disease. Over the years, diagnosis has been problematical due to the variety of types of vascular disease.

Vascular dementias have many causes: Small vessel disease, multi-infarct dementia, strategic strokes, cerebral hypoperfusion, vasculitis, subarachnoid haemorrhage, genetic causes, and cerebral amyloid angiopathy. Clinical features also differ in patients.

Oral anticoagulants are highly effective for preventing cardioembolic strokes, their effectiveness in noncardioembolic strokes is uncertain. Antiplatelet agents, including aspirin have been shown to reduce the incidence of second strokes. Sqad is right in pointing out that if the condition was due to bleeding, aspirin may indeed have made it worse.

I'm inclined to think that in this case, the vascular dementia did not originate from a stroke but I can't be certain.

[theprof]

As Sqad says DEN53, you need to consult with your mum's doctors about this. They have the clinical case notes. I very much doubt that they'll be prepared to put the vascular dementia down to a specific cause.

[jomifl]

just tried a little experiment, 5ml of vinegar in 200 ml tap water, should give a pH of about 5, added some pasteurised milk and the milk coagulated in a few seconds. What part of the milk is supposed to protect the digestive tract from aspirin erosion? given that the hydrochloric acid in the stomach has a pH of about 2. If aspirin is absorbed by diffusion as the Prof says it has to be in solution, if the crystals do the damage you would expect the damage to occur at the top end of the small intestine not at the lower end as sqad says occurs. Any explanation for this apparent contradiction?

[BertiWooster]

Sqad / prof

1. So am I correct in saying that there is no medical consensus on the taking of aspirin by healthy people ?

2. In the case of my family member and his mini stoke ( TIA ) + PFO closure - the thing for him to do is to continue taking aspirin as instructed , following his operation ?

3. What is the advantage of taking Enteric coated aspirin as opposed to
non enteric coated aspirin ?

[theprof]

Oh dear jomifl. Believe me, 5ml of vinegar in 200ml of tap water will not give a solution of pH 5 - having been a university chemistry lecturer, I've done the calculation in my head. I suggest you reconsider.

Lipids protect the stomach from erosion along with the calcium in the milk. You have used the term "digestive tract" rather than the stomach specifically. Finally, I'd point out that I never implied that "crystals do the damage" . I suggest you direct your comments to the poster who did make the assertion.

[theprof]

BertiWooster, answering seriatim

1. yes, you're correct. There is no medical agreement on the issue

2. Yes, I'd suggest that he continues to take the aspirin.

3. Enteric coated tablets are advantageous in that they are coated to dissolve in the intestine rather than the stomach. The coating prevents stomach acid from dissolving the tablets. This per se will minimise the risk of gastric irritation. The marginally increased cost is well worthwhile in potentially susceptible patients.

[BertiWooster]

Thanks prof .

I was just looking on the web after my last post and came across this -

// You might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack or stroke. If you've been on daily aspirin therapy and want to stop, it's important to talk to your doctor before making any changes. Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot //

That is supprising - is that correct ?

Also , what would be the likely consequence of stopping taking statins after you have been taking them for a while ?

[theprof]

BertieWooster, please disregard the contents of the extract you posted. There is no scientific basis for the assertions made, so it's not correct.

As far as the statins issue is concerned, very likely none at all. The inevitable myalgia (muscle aches and pains) suffered by those taking the older statins has been proved to be absent following cessation of statin therapy. Myalgia and associated muscle wastage has been a major cause for concern in the medical profession. Newer statins are considerably more expensive to prescribe and English PCT's are by and large reluctant to cover the additional expenditure. Those living in living in Wales and Scotland have no such restrictions due to their devolved assemblies. For the vast majority of the population, eating a balanced diet sensibly, should eliminate the need for statin therapy.

[Sqad]

Berti.....I can add nothing valuable to the prof´s answers as I agree with all the points that he has covered.

[jomifl]

Hi Prof..you appear to have missed my point re. acetic acid coagulating milk proteins. I know that acetic acid is a weak acid so the pH is not directly proportional to the concentration. Not being a chemist I do not have the the information in my head that would allow me to do a quick calculation, perhaps you would let me know what the pH of my vinegar solution would be? The point that I was making was that the HCl in the stomach has a much lower pH and would therefore also coagulate milk proteins. According to Wiki the solubility of aspirin is about 1g per 100 ml water, I couldn't find out how solubility varies with pH but it would seem at first glance that aspirin in the digestive system would mostly be in solution as indeed it would have to be to be absorbed by diffusion in the small intestine. There appears to be a dearth of information about a subject relevent to the wellbeing of millions of people.

[jomifl]

Re milk coagulation...5 ml vinegar(1 mole approx.) in 200 ml water = pH3.2 approx. Sorry if I misled anyone with my guess of pH 5. This calculation does not take into account the effect of the calcium salts present in the tap water which would raise the pH a little. I do not have the analysis of the tap water to hand at this time but when I come across it I will update the calculation and post it up for all those of you waiting with baited breath.

[Sqad]

jomifl

<<<There appears to be a dearth of information about a subject relevent to the wellbeing of millions of people.<<<

LOL...That doesn´t stop us from pontificating LOL

[BertiWooster]

The prof posted -

// Enteric coated tablets are advantageous in that they are coated to dissolve in the intestine rather than the stomach. //

Prof / sqad

Final couple of clartifications

So the enteric coated aspirin minimises the risk of bleeding in the stomach - is there any risks with it disolving in the intestine ?

I take it that Atorvastatin is not one of the newer statins ?