March 24, 2023

Click this link for more Videos!

So in this video i’m going to cover some reactions of the leadership community in medicine and standards and cardiology and prevention regarding the new information coming out from ascend the ascend trial was published on august 26th in the new england journal it’s regarding at baby aspirin and an omega-3 oils as preventative for heart attack and stroke the ascend

Trial was specific to diabetics and i’ve done a complete video on that i can you can find that on my channel one of my favorite terms is our phrases is it’s just not that simple i get a lot of feedback from my wife and viewers and others that you know what bottom line it just tell us what we should do i’m not so good at that sometimes what i end up doing is telling

You what the facts are and telling my patients what the facts are and then you have to make some of your own choices now it’s very interesting i’m going to go through some of the reactions of the of that the community the medical community that i mentioned a minute ago and you’ll see how there’s so many reactions to this information but first a brief introduction

My name is ford brewer f ord brewer bre wer started off as an er doc anybody that works in the er realizes that most of the stuff that patients bring in the death disease and disability should have been prevented should not be happening so i went to get training did very well enjoyed it and have spent my career helping mostly primary care doc’s but others as well

Learn about the science and how to to do prevention the ascend trial this is a a summary from the european society of cardiology why it was the central was presented simultaneously at the european society of cardiology congress and on the same day that it was published in the new england journal of medicine there were several different trials looking at prevention

Of heart attack and stroke one in using aspirin also in a mega three in in the central the ascend trial was specific to diabetics there was another trial going on a spree which it looked at patients of advanced stage we’ll talk about that one later just a couple of comments about the study just a couple of reminders there were fourteen thousand four hundred and

Eighty patients with diabetes aged 40 and above the average age was 60 they had no cardiovascular disease history but as i’ve mentioned in other places they didn’t do a si imt they can’t say that these patients did not have plaque already what they found was a well let me just read the well they found a an 8.5% occurrence of ischemic transy ischemic attack heart

Attack stroke so nine percent occurred in the placebo trial so you had a one percent decrease in heart attack and stroke there was however a significant increase in hemorrhage so you prevented one type of stroke the ischemic hemorrhage or ischemic stroke which comes from a clot and you ended up increasing and giving a lot of that away with hemorrhagic stroke a

Stroke where you had bleed into the brain but that’s just strokes it also decreased heart attacks but again you also had a lot of gi bleeding now which is worse gi bleeding or heart attack or stroke clearly heart attack or stroke so when you get down to the those details which would you rather have heart attack stroke or gi bleeding most people would choose gi

Bleeding because you can fix that you see how this is starting to get a little bit more complicated at the end of the day here’s some of the responses that you get from the leadership community jane armitage was in the clinical trial service unit at nuffield population of help her her point was aspirin did as expected reduce the risk of serious vascular events

But as expected it significantly increased the risk of major bleeding her point was you have to weigh the benefits first versus the risk here is a comment from mukesh did wanna his was one of the more interesting ones doctor did wanna is the professor of medicine and director of the heart failure program at uc san francisco school of medicine okay his point was

Even though the trial was done with very good intentions missus doctor did wanna very very good intentions i and it studied diabetic patients supposedly at high risk the overall event rate was low and that’s true his point was it’s rare to see or unusual to see an eight point eight point five percent or even nine point five percent heart attack and stroke rate in a

Diabetic population so his point was you get what you still and what you actually selected for in that population had to be a healthy group they did acknowledge that these people were all on tended to be on appropriate dose of treatment with statins and blood pressure medication as well as some other things so his point he said i don’t expect this to make any change

On the guidelines at all and it did what we have always said i’m gonna continue to recommend it for my diabetic patients and we know it’s going to decrease serious cardiovascular complications here’s dr. ileana pena dr. ileana pena is on the she’s in cardiology today editorial board member and she’s also at montefiore medical center in albert einstein college of

Medicine in her cardiology today editorial board position she also interacts with the american heart association guidelines committee her point was i’m gonna be talking with them about this it would probably need to change the guidelines meaning probably do away with the recommendation now let’s go back for a minute to the american heart association i mean the not

The american heart association gala the us pcc preventive services task force guidelines what do they recommend since actually for decades they’ve recommended baby aspirin for people 50 to 60 that are healthy and can take baby aspirin for a year and don’t have a bleeding problem that’s for prevention of heart a heart attack and stroke and cancer for patients 60 and

Older they say look we don’t you need to figure out whether they how do they way things actually the us preventive services task force in the for people 60 and older do have the the same complication excuse me factor that i have with my own patients and that is you pay your money you take your risks or your take your licks as pogos said there are benefits in their

Wrists we’re going to give you some of the the information here and the patient needs to make their own choice and again that choice is which would you rather have an increased risk of gi bleeds some bleeds in the eye and sub bleeds in the brain or a significant increase in heart attack and stroke amaretto ischemic stroke so again i wish i could make it simple for

All of those folks out there who’s saying brewer just bottom-line it make it simple just tell me what to do i’ll give you the information i don’t think anybody wants to to make your decisions regarding prevention for you they could tell you what i would do many people ask that well just to remind you i’m not a candidate for aspirin anymore when i found my atrial

Fib atrial fib put even paroxysmal afib occasional atrial fib which is what i had that puts you at increased risk for stroke significant increased risk for ischemic stroke and aspirin doesn’t help for that you have to take what’s called a noack or you should take that and that’s what i’m taking eliquis if i weren’t taking eliquis what would i do i’m pre-diabetic

I know i’ve got plaque i don’t know i think i would probably remain on baby aspirin i was taking that up until the atrial fib and the eliquis but i tell you it would be awfully tempting to say heck with this the benefits and risks are getting even more and more cloudy foggy as they do my own personal emotion of simplify and quit taking any kind of medicine you

Can avoid taking that would at some point probably take over there’s some other studies coming out about aspirin and primary prevention of heart attack and stroke we’ll cover those in related videos thank you for your attention interest

Transcribed from video
Aspirin, Omega 3s & Heart Attack/Stroke: The ASCEND Trial 2018 – Expert Reactions By Ford Brewer MD MPH