Aspirin Does A Body Good Part 4

Personal care.  Individualized therapies.  We're attempting to move from cookie cutter, cookbook medicine to care that requires interaction & communication.  No where is this more clear than with aspirin.  Over the last few years, we've moved from aspirin for everyone to prevent heart attacks in all to more carefully thought out recommendations as codified by the US Preventive Services Task Force.  In women 55-79yo, we might consider aspirin to prevent ischemic stroke if the benefit outweighs the risk of gastrointestinal hemorrhage.  We're not clear if there's any benefit for those women 80yo & older but we're clear that there's no benefit to gained for those women younger than 55yo.

To add to our fund of knowledge, a prospective, population-based cohort study was published last week in BMJ Open in which the authors concluded that regular low-dose aspirin was associated with less cognitive decline as measured by Folstein's Mini-Mental State Examination after just 5 years.  The authors arrived at their conclusion by evaluating 789 Swedish women 70-92yo.  They found 681 who did not have dementia or use warfarin, clopidogrel or heparin.  Of note, 601 had at least intermediate risk (>10%) per Framingham heart disease calculator but only 129 used low-dose aspirin (75-160mg/d).  The authors followed these 601 women for 5 years but due to attrition, only 489 completed the study.  And yet, using the MMSE, which is not very sensitive for dementia, the authors were able to find differences in outcome in a relative short period of time in intermediate-to-high cardiovascular risk women.

So what's this mean for you & me (or at least the women in our lives)?  As the authors duly noted, this was an observational study.  Therefore, this study did not prove that aspirin prevented cognitive decline but rather linked the two together.  So don't take low-dose aspirin to prevent cognitive decline if you're at intermediate-to-high cardiovascular risk.  But do take low-dose aspirin to prevent ischemic stroke if you're a 55-79yo female in which this potential benefit outweighs the risk for gastrointestinal bleeding.  And if this same dose prevents cognitive decline in your mental function and/or lowers cancer mortality, then enjoy the additional benefit, at least until we have a randomized controlled trial either supporting this study or tearing it down.

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