The Century Legend of Aspirin (2)

Before the above < < Aspirin’s Life Experience Doubts > >

A good [heart] medicine

Almost everyone has experienced such headache, and many people may have taken aspirin and its similar drugs. Why can aspirin relieve pain? This has to start with the relevant mechanism of pain.

In fact, although people have mastered a lot of knowledge about pain so far, However, the mechanism of pain has not been fully clarified. According to the current human understanding of pain, When pain occurs, Locally, some pain-causing chemical factors such as bradykinin will be produced and released. Prostaglandins are also produced and released. Bradykinins can cause pain by acting on pain receptors. Prostaglandins can increase the sensitivity of pain receptors to pain-causing factors such as bradykinin, In other words, prostaglandins amplify the pain caused by bradykinins, etc. If bradykinins are compared to the first evil that oppresses the good, prostaglandins are very much like the dog legs that help to commit abuse. Of course, dog legs occasionally act alone to do some wicked things, just as prostaglandins themselves have pain-causing effects.

This is the secret of aspirin to relieve pain. Because she can inhibit the biosynthesis of prostaglandins in the body, So as to weaken the signals transmitted to the brain through nerves, You should know that all feelings, including pain, are actually just brain feelings. However, aspirin’s analgesic effect is limited after all. It can only have good analgesic effect on clinically common chronic blunt pain such as headache, toothache, neuralgia, muscle or arthralgia, dysmenorrhea, etc. It is of little use for severe traumatic severe pain (such as fracture) and visceral smooth muscle colic (such as colic caused by kidney stones).

Of course, pain itself cannot be treated as [evil]. Most of the time, pain actually plays a protective role in the human body. For example, our talent’s headache is actually a signal from our body to me: Don’t think about that aspirin any more, disobedience will give you a headache! -Hey hey, I don’t obey, take a few aspirin to continue talking about aspirin. (This is harmful to health, readers do not imitate if they don’t want to die from overwork)

The principle that aspirin can reduce fever is also related to prostaglandins. Experiments have proved that Many kinds of prostaglandins produced by whole body tissues have heat-causing effect, and small amounts of prostaglandins can be injected into the ventricle of animals to cause fever. Aspirin can play an antipyretic role by inhibiting the synthesis of prostaglandins in the thermoregulatory center, but it has no cooling effect on normal body temperature.

Speaking of which, we must remind everyone that fever is a defensive reaction of the body, so there is no need to rush to use antipyretic drugs for fever under normal circumstances, but if the fever is too high or lasts too long, it will be harmful to the human body. Only then can antipyretic drugs be used to relieve symptoms and reduce complications.

As far as antipyretics and analgesics are concerned, Aspirin is no longer unique, The new generation of products such as paracetamol (acetaminophen) and ibuprofen (ibuprofen) not only have better therapeutic effects, but also have reduced side effects and are more easily tolerated by the body. Therefore, if only used for antipyretic and analgesic, it is obvious that the world cannot consume more than 100 billion aspirin tablets every year. So, who consumes those large amounts of aspirin?

In 1971, British scientist John Vame discovered that aspirin can prevent platelet coagulation, It can reduce the risk of thrombosis. This research won him the 1982 Nobel Prize. And was awarded the British knighthood. In fact, in the more than 100 years after aspirin was born, The research on her in the medical field is like crucian carp crossing the river. The benefits of aspirin in primary prevention of cardiovascular diseases have been demonstrated in six large-scale randomized clinical trials, namely the British Physician Study (BDT), the American Physician Study (PHS), the Thromboprophylaxis Trial (TPT), the Best Treatment for Hypertension (HOT), the Primary Prevention Study (PPP) and the Women’s Health Study (WHS).

These results show that, Primary prevention with aspirin can significantly reduce major cardiovascular events (fatal and disabling conditions such as myocardial infarction) in the population. What is more interesting is that aspirin shows significant gender differences in performing such effects. Among them, the main benefit for men is to reduce the risk of myocardial infarction, while the main benefit for women is to reduce the risk of ischemic stroke. Why is this?

The possible explanation is that there are gender differences in the incidence of stroke and myocardial infarction. The incidence of stroke in women is higher than that of myocardial infarction, while that in men is opposite. In addition, there are gender differences in aspirin metabolism and human body’s resistance to aspirin, which may also be related to the above results.

Today, tens of thousands of people have benefited from this series of studies. We don’t know if these beneficiaries will silently pay tribute to John Van. But I reckon that John Wing himself will most likely think of another person when he won the Nobel Prize in 1982-Lawrence L. Craven, a doctor from Glendale, California, 1883-1957). Because as early as the 1950s, Craven has published four papers, The paper mentions that, Patients take 1-2 aspirin tablets daily, After a period of observation, No heart infarction occurred after taking the drug. Unfortunately, he did not test the comparison between aspirin and placebo. Therefore, his theory has not received due attention. Not to mention Craven’s regret that he missed the Nobel Prize, If this efficacy of aspirin had been widely recognized 10 years earlier, How many people will benefit in advance? What is more tragic is that Craven himself died of myocardial infarction in 1957. It is ironic to joke about the fate of a man who made outstanding contributions to the prevention research of myocardial infarction and whose results later saved tens of millions of people, but died of myocardial infarction. Why did Craven set the test age range at 45 to 65? Of course, the age of 74 is not short, but if he can expand the scope of application of the test age, maybe he can live a few more years.

(Photo of Dr. Lawrence L. Craven in 1914, at the age of 31, when he graded from the University of Minnesota College of Medicine and Surgery. Photo courtesy of the University of Minnesota Archives.)

It should be pointed out that the risk of cardiovascular adverse events in diabetic patients is 2 to 4 times higher than that in people without diabetes. For many years, aspirin has been recommended as a drug to prevent cardiovascular and cerebrovascular diseases in diabetes by almost all international diabetes guidelines, but there have been some recent media reports to the contrary.

On October 16, 2008, Jill Belch and others of Dundee University reported in the British Medical Journal, Regular use of aspirin and antioxidants does not prevent cardiovascular events and death in people with diabetes and asymptomatic arterial disease. A study published in the Journal of the American Medical Association on November 12 of the same year by Dr. Hisao Ogawa of Kumamoto University in Japan showed that Using low-dose aspirin as the main preventive measure cannot reduce the risk of cardiovascular adverse events in patients with type 2 diabetes.

In fact, this involves the issue of observation points in medical research. If different observations are selected, It is possible to draw inconsistent results. A single medical study often does not have clear conclusions that are either black or white, which may be difficult for non-professionals to understand. However, what is certain is that the above two studies cannot deny the positive role of aspirin in preventing cardiovascular and cerebrovascular risks in diabetic patients.

Aspirin is recommended as a drug to prevent cardiovascular and cerebrovascular diseases in diabetic patients. According to randomized clinical studies in more than 100 specialized diabetes research fields involving nearly 100,000 people worldwide so far, Aspirin can effectively prevent and treat cardiovascular and cerebrovascular events in diabetic patients. The more famous is the American Physician Health Research published in 1989. 22,071 healthy American male physicians who were initially healthy were followed up with oral aspirin for 5 years. Results Aspirin significantly reduced the risk of myocardial infarction in diabetic patients. The 2005 Women’s Health Study, involving 39,876 initially healthy U.S. Female medical personnel, followed up for 10 years with oral aspirin, showed that aspirin also significantly reduced the risk of cerebral infarction in diabetic patients.

News media sometimes quote some research results contrary to the current mainstream conclusions in scientific reports in order to attract attention. From the perspective of paying attention to the frontier and satisfying readers’ curiosity, there is nothing wrong with doing so. However, if scientific interpretation is not added, many patients will often feel at a loss.

In May 2009, the U.S. Prevention Agency Task Force (USPSTF) issued < < Aspirin for Cardiovascular Disease Prevention: USPSTF Recommended Guidelines > >, revising the recommended contents of aspirin for primary prevention of cardiovascular diseases:

(1) Aspirin is recommended for men aged 45-79 when the benefits of reducing myocardial infarction exceed the risk of increasing gastrointestinal hemorrhage.

(2) Aspirin is recommended for women aged 55-79 when the benefits of reducing ischemic stroke exceed the risk of increasing gastrointestinal hemorrhage.

(3) Among the elderly over 80 years old, the existing data are not sufficient to evaluate the benefits and risks of aspirin for primary prevention;

④ Aspirin is not recommended for women under 55 years old to prevent stroke or men under 45 years old to prevent myocardial infarction.

My advice to readers is that if the information you get from the media is inconsistent with the advice of previous doctors, it is better to follow the doctor’s advice. We have seen hospitals compensate patients for improper handling. Have you ever seen a magazine compensate readers for misleading medical information published? If you are using aspirin for prevention now, this article will undoubtedly enhance your confidence in taking aspirin. If you think you should take aspirin according to relevant information, please consult a clinician before making a decision.