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Comment by readhn | Hacker News Reader

here is input from my pharmacist friend on this article:

"Just saw this study come out a few days ago and it kind of is no news. The harm of nsaids has been known and the warnings are out there. I tell patients everyday not to take advil/naproxen if they are older than 40/50 because of the heart and stomach issues.

Will be interesting once they release celebrex as over the counter, this latest study will definitely catapult that process exponentially.

In the mean time, only take nsaids if u really need to, with food and i tell patients to eat frequently and not too much salt to combat the water retention which causes the heart issues."

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Isn't aspirin regularly promoted as being good for your heart?

It is, as well as prevention of stroke and prevention of colon cancer. While in the same general category of NSAIDs, you should think of it as really being a different animal. It has more of an antiplatelet effect than the other NSAIDs these articles are talking about which lead to decreased clotting.

IIRC isn't the number needed to treat on aspirin pretty high, like in the thousands?

I'm not sure how that compares with other treatments or the average but offhand it seems pretty high to the point of asking whether it's worth it.

It depends on what you're trying to prevent and what your risk factors are.

For patients with existing heart disease or prior strokes, the NNT is between 50 and 333 depending on the outcome you're considering. Source:

http://www.thennt.com/nnt/aspirin-for-cardiovascular-prevent...

For prevention of a first heart attack or stroke, the NNT is between 1667 and 3000 depending on the outcome. Notable is that no deaths were prevented by the therapy. Source:

http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-a...

Ah, that makes more sense. I saw the 1667/3000 numbers and was very put off by them.

Correct. Promoting aspirin as "good for the heart" is too generic of a phrase; such generalization may lead to healthy people unnecessarily taking a daily aspirin just because it is "good for the heart".

Aspirin is prescribed for some specific conditions due to its antiplatelet effect. From what I understand, for normal healthy people, there isn't much benefit of daily aspirin. And, there is potential for some side effects -- in addition to the same stomach problems / heartburn issues that plague other NSAIDS also has some bleeding type issues due to the antiplatelet effect.

> Correct. Promoting aspirin as "good for the heart" is too generic of a phrase; such generalization may lead to healthy people unnecessarily taking a daily aspirin just because it is "good for the heart".

Well, Bayer runs (or ran) ads encouraging just that behavior.

> Well, Bayer runs (or ran) ads encouraging just that behaviour.

Such a thing would never fly in Europe. They'd get laughed out of the room and sued.

Be that as it may, their German scruples didn't stop them from running a huge ad campaign in the US to this effect.

I remember those ads. Googling, it looks like the FTC did rebuke Bayer for their behavior in 2000. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070790/

Yeah the NSAIDs warnings are quite consistent. I've been sensitive to them but can tell the benefit as long as I'm taking them appropriately (e.g. infrequent doses, usually with good amount of food). Kind of surprised me Naproxen Sodium is still a script drug some places outside of the US whereas Codeine would otherwise be OTC, basically speaking. I know which I'd rather have access to for pain management.

I have always avoided nsaids if I can, and when I have to take them I always am asked to also take previcid to protect my stomach. I very quickly start to lose hunger and have stomach issues without something else to protect against the nsaid.

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