Aspirin, CVD Risk, & Potential Counter-Risks
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Aspirin Pros & Cons
In Tuesday’s newsletter, we asked your health-related opinion of aspirin, and got the above-depicted, below-described set of responses:
- About 42% said “Most people can benefit from low-dose daily use to lower CVD risk”
- About 31% said “It’s safe for occasional use as a mild analgesic, but that’s all”
- About 28% said “We should avoid aspirin; it can cause liver and/or kidney damage”
So, what does the science say?
Most people can benefit from low-dose daily aspirin use to lower the risk of cardiovascular disease: True or False?
True or False depending on what we mean by “benefit from”. You see, it works by inhibiting platelet function, which means it simultaneously:
- decreases the risk of atherothrombosis
- increases the risk of bleeding, especially in the gastrointestinal tract
When it comes to balancing these things and deciding whether the benefit merits the risk, you might be asking yourself: “which am I most likely to die from?” and the answer is: neither
While aspirin is associated with a significant improvement in cardiovascular disease outcomes in total, it is not significantly associated with reductions in cardiovascular disease mortality or all-cause mortality.
In other words: speaking in statistical generalizations of course, it may improve your recovery from minor cardiac events but is unlikely to help against fatal ones
The current prevailing professional (amongst cardiologists) consensus is that it may be recommended for secondary prevention of ASCVD (i.e. if you have a history of CVD), but not for primary prevention (i.e. if you have no history of CVD). Note: this means personal history, not family history.
In the words of the Journal of the American College of Cardiology:
❝Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk (S4.6-1–S4.6-8).
Low-dose aspirin (75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age (S4.6-9).
Low-dose aspirin (75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding (S4.6-10).❞
~ Dr. Donna Arnett et al. (those section references are where you can find this information in the document)
Read in full: Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology
Or if you’d prefer a more pop-science presentation:
Many older adults still use aspirin for CVD prevention, contrary to clinical guidance
Aspirin can cause liver and/or kidney damage: True or False?
True, but that doesn’t mean we must necessarily abstain, so much as exercise caution.
Aspirin is (at recommended doses) not usually hepatotoxic (toxic to the liver), but there is a strong association between aspirin use in children and the development of Reye’s syndrome, a disease involving encephalopathy and a fatty liver. For this reason, most places have an official recommendation that aspirin not be used by children (cut-off age varies from place to place, for example 12 in the US and 16 in the UK, but the key idea is: it’s potentially dangerous for those who are not fully grown).
Aspirin is well-established as nephrotoxic (toxic to the kidneys), however, the toxicity is sufficiently low that this is not expected to be a problem to otherwise healthy adults taking it at no more than the recommended dose.
For numbers, symptoms, and treatment, see this very clear and helpful resource:
An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose
Take care!
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The Hormone Therapy That Reduces Breast Cancer Risk & More
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The Hormone Balancing Act
We’ve written before about menopausal HRT:
What You Should Have Been Told About Menopause Beforehand
…and even specifically about the considerations when it comes to breast cancer risk:
Menopausal Hormone Replacement Therapy
this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.
Hormone Modulating Therapy
Hormone modulating therapy, henceforth HMT, is something a little different.
Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…
MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,
Isn’t that the opposite of what we want?
You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).
However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.
In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.
Here’s a pop-science article that goes into the details more deeply than we have room for here:
Hormone therapy for breast cancer linked with lower dementia risk
And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:
Want to learn more?
If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:
The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
Take care!
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Sticky Jackfruit Burgers
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All the taste and experience of pulled pork, without the increased risk of cancer and metabolic disease. On the contrary, jackfruit introduces lots of fiber, vitamins, carotenoids, and flavanones. We’ll have to do a main feature about jackfruit sometime; it’s an unusual fruit especially for its protein content, but for now, let’s get cooking!
You will need
- 1 can (14oz/400g) green jackfruit, drained (the flesh will not, in fact, be green—this is referring to the fruit being unripe and thus still firm in texture, which is what we want. The outside of the fruit, which will not be in the can, will have been green)
- 1/4 red cabbage, thinly sliced
- 1/2 carrot, grated
- 6 mangetout, thinly sliced
- 2 tbsp mayonnaise (your preference what kind, and yes, vegan is fine too)
- 1 tbsp extra virgin olive oil
- 1 tbsp gochujang paste (if you can’t find gochujang paste locally, you can either order it online (here it is on Amazon) or substitute with harissa paste, which is not the same—it uses different spices—but will do the same job here re texture, umami taste, and level of spiciness)
- 1 tbsp soy sauce
- 1 tbsp balsamic vinegar
- 1 tsp apple cider vinegar
- 1 tsp garlic paste
- 1 tsp tomato paste
- 1 tsp ginger paste
- 1 tsp chili flakes
- 3½ fl oz water
- 2 burger buns (unless you make them yourself, burger buns will probably not be healthy; you can, however, also look for small round wholemeal breads—the name of which varies far too much by region for us to try to get a catch-all name here—and use them in place of burger buns)
Method
(we suggest you read everything at least once before doing anything)
1) Combine the garlic paste, ginger paste, tomato paste, gochujang paste, soy sauce, balsamic vinegar, and chili flakes in a saucepan
2) Boil the 3½ fl oz water we mentioned; add it to the saucepan, mixing well, turn on the heat and let it simmer for 5 minutes or until it is thick and sticky (it will thicken more as it cools, too, so don’t worry if it doesn’t seem thick enough yet). Set it aside.
3) Dry the jackfruit (using strong kitchen paper should be fine), add the olive oil to a skillet and bring it to a high heat; add the jackfruit and fry on both sides for a few minutes, until it looks cooked (remember, while this may look like animal meat, it’s not, so there’s no danger of undercooking here).
4) When the jackfruit looks a nice golden-brown, add two thirds of the sauce from the saucepan, and break apart the jackfruit a bit (this can be done with a wooden/bamboo spatula, so as to not damage your pan), When it all looks how you’d expect pulled jackfruit (or pulled pork) to look, take it off the heat.
5) Combine the carrot, cabbage, and mangetout in a small bowl, adding the apple cider vinegar and mixing well; this will be the coleslaw element
6) Mix the remaining sauce with the mayonnaise
7) (optional) toast the burger buns
8) Assemble the burgers; we recommend the following order: bottom bun, pulled jackfruit, coleslaw, gochujang mayo, top bun
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake, The Fun Way!
- 10 Ways To Balance Blood Sugars
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Foot Drop!
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Interesting about DVT after surgery. A friend recently got diagnosed with foot drop. Could you explain that? Thank you.❞
First, for reference, the article about DVT after surgery was:
DVT Risk Management Beyond The Socks
As for foot drop…
Foot drop is descriptive of the main symptom: the inability to raise the front part of the foot due to localized weakness/paralysis. Hence, if a person with foot drop dangles their feet over the edge of the bed, for example, the affected foot will simply flop down, while the other (if unaffected) can remain in place under its own power. The condition is usually neurological in origin, though there are various more specific causes:
When walking unassisted, this will typically result in a distinctive “steppage gait”, as it’s necessary to lift the foot higher to compensate, or else the toes will scuff along the ground.
There are mobility aids that can return one’s walking to more or less normal, like this example product on Amazon.
Incidentally, the above product will slightly shorten the lifespan of shoes, as it will necessarily pull a little at the front.
There are alternatives that won’t like this example product on Amazon, but this comes with the different problem that it limits the user to stepping flat-footedly, which is not only also not an ideal gait, but also, will serve to allow any muscles down there that were still (partially or fully) functional to atrophy. For this reason, we’d recommend the first product we mentioned over the second one, unless your personal physiotherapist or similar advises otherwise (because they know your situation and we don’t).
Both have their merits, though:
Trends and Technologies in Rehabilitation of Foot Drop: A Systematic Review
Of course, prevention is better than cure, so while some things are unavoidable (especially when it comes to neurological conditions), we can all look after our nerve health as well as possible along the way:
Peripheral Neuropathy: How To Avoid It, Manage It, Treat It
…as well as the very useful:
What Does Lion’s Mane Actually Do, Anyway?
…which this writer personally takes daily and swears by (went from frequent pins-and-needles to no symptoms and have stayed that way, and that’s after many injuries over the years).
If you’d like a more general and less supplements-based approach though, check out:
Steps For Keeping Your Feet A Healthy Foundation
Take care!
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What I Wish People Knew About Dementia – by Dr. Wendy Mitchell
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We hear a lot from doctors who work with dementia patients; sometimes we hear from carers too. In this case, the author spent 20 years working for the NHS, before being diagnosed with young-onset dementia, at the age of 58. Like many health industry workers who got a life-changing diagnosis, she quickly found it wasn’t fun being on the other side of things, and vowed to spend her time researching, and raising awareness about, dementia.
Many people assume that once a person has dementia, they’re basically “gone before they’re gone”, which can rapidly become a self-fulfilling prophecy as that person finds themself isolated and—though this word isn’t usually used—objectified. Talked over, viewed (and treated) more as a problem than a person. Cared for hopefully, but again, often more as a patient than a person. If doctors struggle to find the time for the human side of things with most patients most of the time, this is only accentuated when someone needs more time and patience than average.
Instead, Dr. Mitchell—an honorary doctorate, by the way, awarded for her research—writes about what it’s actually like to be a human with dementia. Everything from her senses, how she eats, the experience of eating in care homes, the process of boiling an egg… To relationships, how care changes them, to the challenges of living alone. And communication, confusion, criticism, the language used by professionals, or how things are misrepresented in popular media. She also talks about the shifting sense of self, and brings it all together with gritty optimism.
The style is deeply personal, yet lucid and clear. While dementia is most strongly associated with memory loss and communication problems, this hasn’t affected her ability to write well (7 years into her diagnosis, in case you were wondering).
Bottom line: if you’d like to read a first-person view of dementia, then this is an excellent opportunity to understand it from the view of, as the subtitle goes, someone who knows.
Click here to check out What I Wish People Knew About Dementia, and then know those things!
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Can you get sunburnt or UV skin damage through car or home windows?
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When you’re in a car, train or bus, do you choose a seat to avoid being in the sun or do you like the sunny side?
You can definitely feel the sun’s heat through a window. But can you get sunburn or skin damage when in your car or inside with the windows closed?
Let’s look at how much UV (ultraviolet) radiation passes through different types of glass, how tinting can help block UV, and whether we need sunscreen when driving or indoors.
Zac Harris/Unsplash What’s the difference between UVA and UVB?
Of the total UV radiation that reaches Earth, about 95% is UVA and 5% is UVB.
UVB only reaches the upper layers of our skin but is the major cause of sunburn, cataracts and skin cancer.
UVA penetrates deeper into our skin and causes cell damage that leads to skin cancer.
UVA penetrates deeper than UVB. Shutterstock/solar22 Glass blocks UVA and UVB radiation differently
All glass used in house, office and car windows completely blocks UVB from passing through.
But only laminated glass can completely block UVA. UVA can pass through other glass used in car, house and office windows and cause skin damage, increasing the risk of cancer.
Car windscreens block UVA, but the side and rear windows don’t
A car’s front windscreen lets in lots of sunshine and light. Luckily it blocks 98% of UVA radiation because it is made of two layers of laminated glass.
But the side and rear car windows are made of tempered glass, which doesn’t completely block UVA. A study of 29 cars found a range from 4% to almost 56% of UVA passed through the side and rear windows.
The UVA protection was not related to the car’s age or cost, but to the type of glass, its colour and whether it has been tinted or coated in a protective film. Grey or bronze coloured glass, and window tinting, all increase UVA protection. Window tinting blocks around 95% of UVA radiation.
In a separate study from Saudi Arabia, researchers fitted drivers with a wearable radiation monitor. They found drivers were exposed to UV index ratings up to 3.5. (In Australia, sun protection is generally recommended when the UV index is 3 or above – at this level it takes pale skin about 20 minutes to burn.)
So if you have your windows tinted, you should not have to wear sunscreen in the car. But without tinted windows, you can accumulate skin damage.
UV exposure while driving increases skin cancer risk
Many people spend a lot of time in the car – for work, commuting, holiday travel and general transport. Repeated UVA radiation exposure through car side windows might go unnoticed, but it can affect our skin.
Indeed, skin cancer is more common on the driver’s side of the body. A study in the United States (where drivers sit on the left side) found more skin cancers on the left than the right side for the face, scalp, arm and leg, including 20 times more for the arm.
Another US study found this effect was higher in men. For melanoma in situ, an early form of melanoma, 74% of these cancers were on the on the left versus 26% on the right.
Earlier Australian studies reported more skin damage and more skin cancer on the right side.
Cataracts and other eye damage are also more common on the driver’s side of the body.
What about UV exposure through home or office windows?
We see UV damage from sunlight through our home windows in faded materials, furniture or plastics.
Most glass used in residential windows lets a lot of UVA pass through, between 45 and 75%.
Residential windows can let varied amounts of UVA through. Sherman Trotz/Pexels Single-pane glass lets through the most UVA, while thicker, tinted or coated glass blocks more UVA.
The best options are laminated glass, or double-glazed, tinted windows that allow less than 1% of UVA through.
Skylights are made from laminated glass, which completely stops UVA from passing through.
Most office and commercial window glass has better UVA protection than residential windows, allowing less than 25% of UVA transmission. These windows are usually double-glazed and tinted, with reflective properties or UV-absorbent chemicals.
Some smart windows that reduce heat using chemical treatments to darken the glass can also block UVA.
So when should you wear sunscreen and sunglasses?
The biggest risk with skin damage while driving is having the windows down or your arm out the window in direct sun. Even untinted windows will reduce UVA exposure to some extent, so it’s better to have the car window up.
For home windows, window films or tint can increase UVA protection of single pane glass. UVA blocking by glass is similar to protection by sunscreen.
When you need to use sunscreen depends on your skin type, latitude and time of the year. In a car without tinted windows, you could burn after one hour in the middle of the day in summer, and two hours in the middle of a winter’s day.
But in the middle of the day next to a home window that allows more UVA to pass through, it could take only 30 minutes to burn in summer and one hour in winter.
When the UV index is above three, it is recommended you wear protective sunglasses while driving or next to a sunny window to avoid eye damage.
Theresa Larkin, Associate Professor of Medical Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hold Me Tight – by Dr. Sue Johnson
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A lot of relationship books are quite wishy-washy. This one isn’t.
This one is evidenced-based (and heavily referenced!), and yet at the same time as being deeply rooted in science, it doesn’t lose the human touch.
Dr. Johnson has spent her career as a clinical psychologist and researcher; she’s the primary developer of Emotionally Focused Therapy (EFT), which has demonstrated its effectiveness in over 35 years of peer-reviewed clinical research. In other words, it works.
EFT—and thus also this book—finds roots in Attachment Theory. As such, topics this book covers include:
- Recognizing and recovering from attachment injury
- How fights in a relationship come up, and how they can be avoided
- How lot of times relationships end, it’s not because of fights, but a loss of emotional connection
- Building a lifetime of love instead, falling in love again each day
This book lays the groundwork for ensuring a strong, secure, ongoing emotional bond, of the kind that makes/keeps a relationship joyful and fulfilling.
Dr. Johnson has been recognized in her field with a Lifetime Achievement Award, and the Order of Canada.
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