Author Interviews, Cancer Research, JAMA, NCI, Ovarian Cancer / 21.04.2023 Interview with: Lauren Hurwitz, PhD Postdoctoral Fellow Division of Cancer Epidemiology & Genetics National Cancer Institute What is the background for this study? What are the main findings? Response: Prior studies have demonstrated that frequent (i.e., daily or near daily) use of aspirin is associated with a lower risk of developing ovarian cancer. We sought to determine if this risk reduction is also observed for individuals with greater genetic susceptibility to ovarian cancer, who may benefit more from preventive interventions. Our study found that individuals who took aspirin frequently had a lower risk of ovarian cancer, regardless of whether they had higher or lower genetic susceptibility to ovarian cancer. (more…)
Author Interviews, Heart Disease, JAMA / 04.05.2022 Interview with: Gbenga Ogedegbe, MD, MPH Dr. Adolph & Margaret Berger Professor of Population Health Director, Division of Health & Behavior Director Center for Healthful Behavior Change Department of Population Health NYU Langone Health NYU School of Medicine Member of the U.S. Preventive Services Task Force  What is the background for this study?  What are the main findings? Response: Heart disease and stroke are the leading causes of mortality in the United States, accounting for more than one in four deaths. Taking a daily aspirin may help prevent a first heart attack or stroke in some people, but it can also cause some harm, like internal bleeding. The decision on whether or not to start taking a daily aspirin should be based primarily on age, but cardiovascular disease risk, a person’s chances of bleeding, and other factors should also be taken into account. (more…)
Author Interviews, Kidney Disease / 08.11.2021 Interview with: Csaba P Kovesdy MD FASN Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163 What is the background for this study? Response: Microinflammation may be a mechanism contributing to adverse outcomes in patients with chronic kidney disease (CKD). Low dose aspirin (ASA) is usually used as an antiplatelet agent for cardiovascular indications, but may also have beneficial effects on kidney function by reducing microinflammation.  (more…)
Author Interviews, COVID -19 Coronavirus, Critical Care - Intensive Care - ICUs / 24.10.2020 Interview with: Michael Mazzeffi MD MPH MSc Associate Professor of Anesthesiology Division Chief Anesthesiology Critical Care Medicine Medical Director Rapid Response Team What is the background for this study? Response: We have known for some time that COVID19 is characterized by hypercoagulability or excess blood clotting.  In fact, the incidence of blood clots in the lungs (pulmonary emboli) is as high 20% and is two to three times more common in COVID19 than in severe influenza.  Further, autopsies of patients who died from COVID19 have shown that endothelial cells (cells that line the blood vessels) are damaged and that "micro clots" form in multiple organs.  Together, these findings strongly suggest that excess blood clotting and endothelial cell dysfunction are defining features of severe COVID19. For several months, my colleagues and I have been interested in whether aspirin might improve outcomes in patients with severe COVID19.  In prior observational research studies, aspirin was found to be protective in patients with severe lung injury.  The general idea is that aspirin reduces platelet aggregates in the lung and this improves outcome.  Unfortunately, in a prior randomized controlled study (LIPS-A) aspirin was not shown to reduce the incidence of acute respiratory distress syndrome.  Nevertheless, COVID19 has unique features that make aspirin more likely to be effective.  Mainly COVID19 is associated with hypercoagulability to a greater degree than in other viral illnesses.  (more…)
Author Interviews, Heart Disease, JAMA, Lipids / 21.08.2020 Interview with: First Author Dhruv Mahtta, DO, MBA Cardiovascular Disease Fellow Baylor College of Medicine Houston, TX Senior & Corresponding Author Salim S. Virani, MD, PhD, FACC, FAHA, FASPC Professor, Section of Cardiovascular Research Director, Cardiology Fellowship Training Program Baylor College of Medicine Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center Co-Director, VA Advanced Fellowship in Health Services Research & Development Michael E. DeBakey VA Medical Center, Houston, TX What is the background for this study? Response: The incidence of atherosclerotic cardiovascular disease among young patients has been on the rise. These patients with premature and extremely premature atherosclerotic cardiovascular disease experience similar rates of mortality compared to older adults. Additionally, these young patients have a greater accrued rate of life-time morbidity. Therefore, secondary prevention measures such as use of guideline concordant statin therapy and aspirin therapy are paramount in this population.  (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Pancreatic / 17.04.2020 Interview with: Dr Cristina Bosetti PhD Head of the Unit of Cancer Epidemiology Mario Negri Department of Oncology Milan Italy What is the background for this study? Response: Aspirin has been known since long time to have a beneficial effect in the primary and secondary prevention of cardiovascular diseases. Additional evidence indicates that it has also a favorable role on the risk of various cancers. (more…)
Alzheimer's - Dementia, Author Interviews, Cognitive Issues / 28.03.2020 Interview with: Joanne Ryan, PhD Senior Research Fellow, ASPREE From the School of Public Health and Preventive Medicine Monash University Melbourne, Australia What is the background for this study? Response: Aspirin is a commonly used drug known to reduce inflammation, and prevent blood clotting (antiplatelet) - which is why it is commonly used in secondary prevention in individuals with established cardiovascular disease. Inflammation is thought to be a central mechanism in Alzheimer's disease, implicated in the neuropathological cascade leading to the development of dementia and other forms of dementia. Cardiovascular risk factors and stroke are both associated with cognitive decline and an increased risk of dementia. This formed the basis of the hypothesis that aspirin could be beneficial in helping to reduce cognitive decline and the occurrence of Alzheimer's Disease. (more…)
Annals Internal Medicine, Author Interviews, Heart Disease / 17.09.2019 Interview with: Dr Vanessa Selak MBChB, MPH (Hons), PhD, FAFPHM, FNZCPHM Senior Lecturer in the Section of Epidemiology & Biostatistics School of Population Health, Faculty of Medical and Health Sciences University of Auckland What is the background for this study? Response: For people who have already had a cardiovascular event, the benefits of aspirin generally outweigh its harms but the balance of benefits and risks is unclear in primary prevention. It was hoped that the results of three major trials published last year would determine whether or not aspirin had a role in the primary prevention of cardiovascular disease (CVD) among people at intermediate risk of CVD, but these trials recruited participants at lower CVD risk than expected. An updated meta-analysis of aspirin for the primary prevention of CVD, which incorporated the findings from these three trials, has confirmed that aspirin reduces the relative risk of CVD and increases the relative risk of bleeding. We investigated, using an individualized assessment of the absolute cardiovascular benefits of aspirin and its bleeding harms among New Zealand adults aged 30-79 years without established CVD who had their CVD risk assessed in primary care between 2012 and 2016, whether there are individuals without established CVD for whom the absolute cardiovascular benefits of aspirin are likely to outweigh its absolute bleeding harms. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Genetic Research / 19.08.2019 Interview with: Tengteng Wang, PhD, MSPH, MBBS Postdoctoral Research Fellow Department of Epidemiology Harvard T.H. Chan School of Public Health Channing Division of Network Medicine Brigham and Women's Hospital What is the background for this study? Response: Chronic inflammation is a key player in the development of multiple cancer types, including breast cancer. Aspirin is one of the major non-steroidal anti-inflammatory drugs (NSAIDs) which clearly has anti-inflammatory properties. Given this, substantial evidence from laboratory and population studies suggests that taking aspirin may reduce the risk of developing breast cancer. However, the association of aspirin use with death outcomes following breast cancer diagnosis remains inconclusive and inconsistent across studies. Therefore, we choose to focus on mortality outcomes in this paper and we hypothesized that the inconsistent results for aspirin in relation to mortality could be due to differences in the association by patients’ biological profiles, specifically DNA methylation profiles here.  (more…)
Annals Thoracic Surgery, Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Geriatrics, Heart Disease, Primary Care / 23.07.2019 Interview with: Christina C. Wee, MD, MPH Associate Professor of Medicine Harvard Medical School Director , Obesity Research Program Division of General Medicine Beth Israel Deaconess Medical Center (BIDMC) Associate Program Director, Internal Medicine Program, BIDMC Deputy Editor of the Annals of Internal Medicine What is the background for this study? Response: New research is showing that for many people without diagnosed heart disease, the risk of bleeding may outweigh the benefits of taking a daily aspirin particularly in adults over 70 years of age.  The American Heart Association and the American College of Cardiology recently updated their guidelines and now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke. Our study found that in 2017,  a quarter of adults aged 40 years or older without cardiovascular disease – approximately 29 million people – reported taking daily aspirin for prevention of heart disease. Of these, some 6.6. million people did so without a physician's recommendation. (more…)
Author Interviews, Heart Disease, JACC / 12.06.2019 Interview with:

J.L. Mehta, MD, PhD

Distinguished Professor of Medicine and Physiology and Biophysics

Stebbins Chair in Cardiology

University of Arkansas for Medical Sciences

Central Arkansas Veterans Healthcare System

Little Rock, AR 72205 What is the background for this study? What are the main findings?  Response: Aspirin is commonly used for primary prevention of cardiovascular disease events in a variety of subjects around the world. Recent studies, however, show that routine use of aspirin without assessment of risk for cardiovascular disease events may not be appropriate, and may even be harmful.  (more…)
Author Interviews, Cancer Research, Colon Cancer, JAMA / 07.05.2019 Interview with: Prof. Dr. med. Hermann Brenner Clinical Epidemiology and Aging Research Division Head German Cancer Research Center Foundation under Public Law Germany What is the background for this study? Response: Colorectal cancer is the third most common cancer globally, accounting for almost 900.000 deaths every year. Most of these deaths could be prevented by screening colonoscopy with early detection and removal of precursors of the cancer. However, capacities and use of screening colonoscopy are limited in most parts of the world, and low-cost but reliable noninvasive screening tests are important alternative primary screening tests. The currently best established noninvasive tests are fecal immunochemical tests for hemoglobin (FITs) which are offered for colorectal cancer screening in an increasing number of countries. Although FITs detect the majority of colorectal cancers they detect approximately one out of four advanced adenomas only, the precursors of most colorectal cancers. We hypothesized that this proportion could be increased by taking a single pill of aspirin two days prior to collecting the stool sample for FIT, because the well-established antithrombotic effects of aspirin might favor detecting occult bleeding from colorectal cancer or its precursors. (more…)
Annals Internal Medicine, Author Interviews, Cancer Research, Prostate Cancer / 05.03.2019 Interview with: Charlotte Skriver, PhD student, MSc Danish Cancer Society Research Center Statistics & Pharmacoepidemiology Danish Cancer Society Copenhagen What is the background for this study?   Response: The drug aspirin is widely used due to its established protection against cardiovascular diseases. Increasing evidence also supports an effect of aspirin use on reducing the risk of and mortality from colorectal cancer and possibly other cancer types. Recent studies have suggested that aspirin use after a diagnosis of prostate cancer may improve the prognosis. We examined whether use of low-dose aspirin was associated with survival after prostate cancer in a nationwide study of prostate cancer patients in Denmark. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JAMA / 05.03.2019 Interview with: Geoffrey Barnes, MD, MSc Assistant Professor Vascular and Cardiovascular Medicine University of Michigan What is the background for this study? What are the main findings? Response: Both aspirin and warfarin are commonly used medications meant to prevent thrombotic complications, but might increase rates of bleeding complications. We used a multi-center anticoagulation collaborative to explore how often patients being treated with warfarin were also taking aspirin but without a clear indication. We found that more than one-third (37.5%) of warfarin-treated patients without a clear reason for aspirin therapy were receiving aspirin. And these patients on both warfarin and aspirin experienced higher rates of bleeding and emergency department visits for bleeding than the patients taking warfarin alone. There were no differences in the rate of thrombotic events between the patients taking warfarin alone or those taking warfarin plus aspirin.  (more…)
Annals Internal Medicine, Author Interviews, Clots - Coagulation, Heart Disease / 27.02.2019 Interview with: Dr Vanessa Selak, MBChB, MPH, PhD, FAFPHM, FNZCPHM Senior Lecturer, Section of Epidemiology & Biostatistics School of Population Health Faculty of Medical and Health Sciences University of Auckland What is the background for this study? Response: In order to determine the balance of benefits and harms of aspirin in primary prevention there’s a need to know an individual’s risk of CVD and their risk of a major bleed without aspirin. We have lots of equations that can be used to determine, among people considering aspirin for primary prevention, an individual’s risk of CVD, but few bleeding risk equations that can be used to determine their risk of a major bleed. We sought to develop a bleeding risk equation that can be used to determine the risk of a major bleed among people in whom aspirin is being considered for the primary prevention of CVD. (more…)
Author Interviews, Hematology, NEJM, Orthopedics, Thromboembolism / 22.02.2018 Interview with: Dr. David R. Anderson, MD, FRCPC, FACP Faculty of Medicine Dean, Professor Dean, Faculty of Medicine Division of Hematology, Department of Medicine & Nova Scotia Health Authority What is the background for this study? What are the main findings? Response: Blood clots in the lungs (pulmonary embolism) and veins of the legs (deep vein thrombosis) are well recognized complications following total hip and knee arthroplasty surgeries.  Prior to the routine use of antithrombotic prophylaxis, pulmonary embolism was the most common cause of death following these procedures.  Oral anticoagulants such as rivaroxaban are commonly prescribed for the indication of preventing blood clots following total hip or knee arthroplasty.  For maximal benefit these agents are continued following surgery for up to five weeks following total hip arthroplasty and for two weeks following total knee arthroplasty. There is evidence that aspirin has some benefit for the prevention of deep vein thrombosis and pulmonary embolism following total hip or knee arthroplasty.  However there is less evidence for its benefit than for oral anticoagulants.  We reasoned that aspirin would potentially be an attractive alternative for extended out of hospital prophylaxis following total hip or knee arthroplasty for patients who received a short course (5 days )of rivaroxaban following surgery.  Aspirin would be attractive for this indication because of its low cost, ease of use, and low rates of side effects. Our study demonstrated that in a randomized controlled trial involving a large group (over 3400) of patients undergoing total hip or knee arthroplasty that extended therapy with aspirin was comparable to rivaroxaban for the prevention of deep vein thrombosis and pulmonary embolism following surgery.  Low rates of complications (< 1%) were observed with both treatment arms.  We also found that rates of clinically important bleeding complications (the most common side effect with antithrombotic drugs) were uncommon and similar with the two agents. (more…)
Author Interviews, Kidney Disease / 20.04.2017 Interview with: Francesco Violi MD Department of Internal Medicine and Medical Specialties e Sapienza University Rome, Italy What is the background for this study? What are the main findings? Response: The paper reports on the protocol of a trial where we will test the effect of aspirin on renal disease progression in diabetic patients. The study will start shortly and will be terminate next year. (more…)
AHA Journals, Allergies, Author Interviews, Heart Disease / 27.02.2017 Interview with: Dr. Roberta Rossini, MD, PhD USC Cardiologia, Cardiovascular Department Bergamo, Italy What is the background for this study? What are the main findings? Response: Aspirin (ASA) is stilll the cornerstone of antithrombotic therapy in patients with coronary artery disease, especially after PCI, both in the acute and the chronic phase of treatment. However, ≈2% of patients have hypersensitivity to ASA. ASA desensitization may represent a valid approach. Desensitization protocols generally involve gradual increases in patient exposure to ASA with the goal of mitigating or abolishing immune-mediated reaction. However, many desensitization protocols require several days to be completed, making them unpractical. This may also contribute to the limited experience with applying ASA desensitization protocols in real-world practice in patients with CAD. We previously reported the results of a pilot investigation supporting the feasibility of performing a rapid (<6 hours) Aspirin desensitization protocol in patients undergoing PCI with stent implantation (Rossini R, Angiolillo DJ, Musumeci G, Scuri P, Invernizzi P, Bass TA, Mihalcsik L, Gavazzi A. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol. 2008;101:786–789. doi: 10.1016/j.amjcard.2007.10.045). The encouraging findings from our pilot feasibility investigation prompted the design of a larger scale multicenter investigation aimed to assess the safety and efficacy of a rapid aspirin  desensitization protocol in patients with a history of ASA hypersensitivity undergoing coronary angiography. (more…)
Author Interviews, Stroke / 26.02.2017 Interview with: Professor Philip Bath Stroke Association Professor of Stroke Medicine/Head of Division of Clinical Neuroscience Faculty of Medicine & Health Sciences University of Nottingham What is the background for this study? What are the main findings? Response: Blood thinning (antiplatelets) drugs reduce further strokes (recurrence) after stroke and mini-stroke (TIA). One antiplatelet, such as aspirin, is better than none, and two different drugs are better than one. The question then is whether three would be better still, providing excess bleeding is not problematic. 3096 patients with ischaemic stroke (stroke due to a blood clot) or mini-stroke were enrolled within 48 hours. They were randomised to take intensive separate antiplatelet therapy (three drugs comprising aspirin, clopidogrel and dipyridamole) or guideline therapy (either clopidogrel alone, or combined aspirin and dipyridamole) for 30 days (after which they took guideline treatment). At 90 days we assessed whether patients had had another stroke or mini-stroke, and how dependent or disabled this had left them. There were slightly fewer recurrent strokes and mini-strokes between intensive and guideline treatment but the difference was not different statistically, so a neutral trial. In contrast, major bleeding was significantly increased in the intensive group as compared with guideline treatment. When looking at the net benefit/harm, there was no difference between the treatment groups. (more…)
Author Interviews, Infections, Pharmacology / 09.02.2017 Interview with: Dr. Fernanda Buzzola IMPaM, UBA-CONICET What is the background for this study? Response: Staphylococcus aureus represents a serious problem to public health due to methicillin-resistance and the bacterial persistence over a long period of time in the host. Approximately the 20% of the human population is at risk to acquire an endogenous infection by S. aureus as a consequence of its asymptomatic nasal colonization. Aspirin, the main source of salicylic acid in the human host, is currently taken by millions of human beings worldwide without medical prescription and widely indicated for defined purposes, including prevention of coronary thrombosis. Salicylic acid is a plant hormone known too for its use as a key ingredient in anti-acne preparations and medications for skin conditions. We also consume mild doses of salicylic acid when we eat fruits and vegetables. Iron is an important trace element for the human body and plays an essential role in blood formation. The metabolism of many bacteria, including S. aureus, also depends on the availability of iron molecules. Salicylic acid forms complexes with iron ions in the blood and so deprives not only us but also the staphylococcal bacteria of this element. S. aureus modifies its metabolism if the iron content is insufficient. The microorganism reacts to the changed – from its perspective, negative – conditions through the intensified formation of a biofilm, a sort of layer of slime formed by the aggregation of individual bacteria. The enhanced biofilm production allows the bacteria to survive for an even longer period under unfavourable living conditions. (more…)
Author Interviews, Heart Disease, NEJM, Pharmacology / 25.02.2016 Interview with: Professor Paul Myles MBBS, MPH, MD, FCARCSI, FANZCA, FRCA Director, Dept of Anaesthesia and Perioperative Medicine Alfred Hospital and Monash University, Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Dr. Myles: When we set up this study 10 years ago there was marked variation in practice for  people taking aspirin waiting for coronary artery bypass surgery.  About half were being told that they must stop their aspirin 5-7 days before surgery, and the other half were told that they should stay on their aspirin. This variation existed across different countries, different cities, and even within a single hospital. Doctors had varied opinions because reliable medical research was sparse; the evidence was contradictory. We thus designed a definitive clinical trial in which half the patients were randomly assigned to receive aspirin and the other half received a placebo. Our study has shown that aspirin is safe (i.e. it does not increase the bleeding risk). We also found that there does not appear to be a benefit during and after surgery, but in view of the clear benefits that exist in daily life, including the preoperative waiting period, we recommend that people should stay on their aspirin if they are having coronary artery surgery. (more…)
Author Interviews / 14.10.2015 Interview with: Prof. Daniel Klessig Professor at  Boyce Thompson Institute and Cornell University Medical Research: What is the background for this study? Prof. Klessig: Acetyl salicylic acid, commonly called aspirin, has been the most widely used drug worldwide for more than a century. Currently, 80 million pounds of aspirin are produced worldwide every year and almost 30 billion tablets are consumed annually in the US alone. Long before German pharmacologist Johann Buchner identified the salicylic acid derivative salicin in 1828 as the ingredient in willow bark that is responsible for its therapeutic effects, different cultures throughout the world were, and many still are, using a variety of plants rich in salicylic acid derivatives, such as willow, wintergreen, and meadowsweet, to treat pain, fever, swelling, and other maladies. Aspirin also is used to reduce the risk of heart attack, stroke, and certain cancers. One might expect that aspirin’s mechanisms of action would be well understood, given its extraordinarily widespread use and the fact that it was first synthesized by the Bayer chemist Felix Hoffmann over 100 years ago. The prevailing view in the biochemical community has been that aspirin works primarily, if not exclusively, by irreversibly inhibiting the enzymatic activities of cyclooxygenases 1 and 2 (COX1 and COX2), thereby disrupting the synthesis of inflammation-inducing prostaglandins. However, this assumption ignores two important facts. First, aspirin is rapidly converted to salicylic acid (SA) in the body. Indeed, almost all aspirin is metabolized to SA within an hour after ingestion. Second, SA and many of its natural plant derivatives are rather poor inhibitors of COX1 and COX2 as compared to aspirin, yet SA and aspirin have nearly the same beneficial pharmacological effects. Thus, there must be additional targets through which aspirin/SA exerts its many effects. Over the past two decades, a number of proteins whose activities are altered by aspirin/SA have been identified; however, their relevance as aspirin/SA targets has been called into question due to the very high, non-physiological levels of aspirin/SA required to alter their activities. In light of our unexpected discovery that SA mediates its physiological effects in plants via many targets, and given that SA is a key hormone produced by all plants, we hypothesized that there might be multiple targets through which SA acts in animals, regardless of whether it is obtained in low to moderate levels via the diet or in moderate to high doses through herbal-based medicines or aspirin usage.  Medical Research: What are the main findings? Prof. Klessig: To investigate whether aspirin/SA exerts its pharmacological activities by targeting proteins besides the cyclooxygenases in humans, we used high-throughput approaches developed to identify proteins that mediate SA signaling in plant immunity. This strategy identified several proteins that bind SA and as a result they exhibit altered activity, including High Mobility Group Box1 (HMGB1). In the body, HMGB1 is normally found inside the cell’s nucleus where it helps package the DNA so that it fits in the nucleus. However, HMGB1 also can be released outside of cells following tissue injury or secretion by certain immune or cancer cells. Once in this extracellular location, HMGB1 triggers inflammation by recruiting immune cells involved in fighting infection and repairing damaged tissue. HMGB1 also stimulates these recruited immune cells to express genes that code for pro-inflammatory signaling proteins called cytokines. These pro-inflammatory activities of HMGB1 are associated with many prevalent and devastating diseases, including rheumatoid arthritis, lupus, heart disease, sepsis, and colorectal and mesothelioma cancers. In collaboration with Marco Bianchi’s group at San Raffaele University and Research Institute in Milan, Italy and Gaetano Montelione’s group at Rutgers University in New Jersey, we have discovered that SA binds to HMGB1, thereby blocking its pro-inflammatory activities. It does so at concentrations that are far lower than those required to suppress the enzymatic activity of COX1 and COX2. Notably, we have discovered that HMGB1 also induces the expression of the gene encoding COX2, and that low levels of SA suppress this induction. Thus, SA does act, in part, through its effect on cyclooxygenase, but it does so by inhibiting the production rather than the activity of this enzyme. The discovery that HMGB1’s various pro-inflammatory activities are inhibited by low levels of SA provides at least one likely explanation for the protective effects of low-dose aspirin usage. Importantly, we also have identified several natural and synthetic derivatives of SA that bind to HMGB1 more tightly than aspirin/SA and inhibit its pro-inflammatory activities much more effectively (40 -1000 fold). Interestingly, these natural derivatives are produced by an herb used in traditional Chinese medicine, while the synthetic derivative was designed based on both the structure of the herbal derivative and our studies of the binding activities of other SA-like compounds with HMGB1 and other SA-binding proteins from plants and humans.      In conclusion, the identification of HMGB1 as a novel pharmacological target of SA/aspirin provides new insights into the mechanisms of action through which this widely used drug reduces inflammation and inflammation-associated diseases. Moreover, the existence of natural and synthetic SA derivatives that are even more potent than aspirin/SA at suppressing HMGB1’s pro-inflammatory activities argues that there is tremendous potential for developing SA-based drugs that retain all of the beneficial properties of SA but lack its deleterious side effects. (more…)
Author Interviews, Cancer Research / 28.09.2015

M.A. Frouws, Study Coordinator ASPIRIN trial MD PhD Candidate Datacenter Heelkunde, K6-R Leiden University Medical Center Leiden, the Interview with: M.A. Frouws, Study Coordinator ASPIRIN trial MD PhD Candidate Datacenter Heelkunde, K6-R Leiden University Medical Center Leiden, the Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The effect of aspirin on cancer survival has been the topic of many studies for a few decades. Epidemiological evidence shows a dual role in the relation between aspirin and cancer; both preventative and therapeutic effects are suggested. The biological mechanism of the effect of aspirin on cancer is still part of debate. However research up until now was mainly done at a single tumor location, mostly colorectal cancer. Since little is known about the etiology of the effect of aspirin, we have undertaken in this study. The aim of this study was to investigate the effect of the use of aspirin after diagnosis on survival in patients with cancer from the gastrointestinal tract. Stratification in specific localizations in the entire gastro intestinal tract could lead to new insights towards the effect of aspirin as a therapeutic agent. We studied 13.715 patients and found a really significant survival benefit in patients taking aspirin after diagnosis of gastrointestinal malignancies, except for pancreatic cancer. Survival in patients with gastro intestinal malignancies taking aspirin after diagnosis showed to be twice as high as patients not taking aspirin. At five years after diagnosis, 75% of patients were alive who took aspirin, versus 42% of the patient group not taking aspirin. This effect persisted after correcting for several confounding factors, including age, disease stage and comorbidity. (more…)
Annals Internal Medicine, Author Interviews, Colon Cancer / 25.08.2015

Søren Friis, Senior Scientist, Associate Professor, MD Danish Cancer Society Research Center Danish Cancer Society Department of Public Health University of Copenhagen Faculty of Health Institute of Clinical Medicine Department of Clinical Epidemiology Aarhus University Interview with: Søren Friis, Senior Scientist, Associate Professor, MD Danish Cancer Society Research Center Danish Cancer Society Department of Public Health University of Copenhagen Faculty of Health Institute of Clinical Medicine Department of Clinical Epidemiology Aarhus University Denmark Medical Research: What is the background for this study? Dr. Friis: Although laboratory, clinical, and epidemiological studies have all provided strong evidence for protection against colorectal cancer from regular use of aspirin, the optimal dose and duration of use for cancer prevention remain to be established. Medical Research: What are the main findings? Dr. Friis: Continuous use of low-dose aspirin for five or more years was associated with a reduced risk of colorectal cancer, but overall long-term use (continuous or non-continuous) was not. Long-term, high-intensity use (average of ≥0.3 daily doses) of non-aspirin NSAIDs was associated with a substantially reduced risk of colorectal cancer, particularly for NSAIDs with the highest COX-2 selectivity. The results for long-term continuous users of low-dose aspirin should be interpreted cautiously, since these patients comprised only a small proportion of the low-dose aspirin users and might have a risk profile different from that of the general population. (more…)
Author Interviews, CDC, Heart Disease, Stroke / 23.07.2015

Dr. Jing Fang Ph.D. Epidemiologist Center For Disease Interview with: Dr. Jing Fang Ph.D. Epidemiologist Center For Disease Control MedicalResearch: What is the background for this study? What are the main findings? Dr. Fang: Although the effectiveness of aspirin for secondary prevention (e.g. people who already have coronary heart disease or have had an ischemic stroke) of cardiovascular disease has been determined, its prevalence as a preventive measure has varied widely across settings, data collection methods and U.S. states. As a result, we wanted to more closely examine aspirin use among U.S. adults with a history of coronary heart disease or stroke. To determine these findings, we analyzed data from the 2013 Behavioral Risk Factor Surveillance System. Nearly 18,000 people from 20 states and the District of Columbia with a self-reported history of coronary heart disease or stroke were included in the annual telephone survey. Overall, we found about 70 percent of U.S. adults with heart disease or stroke reported regularly taking aspirin – meaning every day or every other day. Out of that group, nearly 94 percent said they take aspirin for heart attack prevention, about 80 percent linked it to stroke prevention efforts, and approximately 76 percent said they use it for both heart attack and stroke prevention. However, four percent of respondents with pre-existing cardiovascular problems said they take aspirin for pain relief without awareness of its benefits for cardiovascular disease. Aspirin use also differed by state and sociodemographic characteristics including gender, race/ethnicity and age. In general, men, non-Hispanic whites, individuals aged 65 and older, and people with at least two of four risk factors (hypertension, smoking, diabetes and high cholesterol) are more likely to use aspirin than other groups. By state, aspirin use ranged from 44 percent in Missouri to more than 71 percent in Mississippi. (more…)
Author Interviews, Cancer Research / 16.07.2015

Dr-Haining-Yang Interview with: Haining Yang MD Ph.D Associate Professor Thoracic Oncology Program University of Hawaii Cancer Center University of Hawaii, Honolulu, HI Medical Research: What is the background for this study? Dr. Yang: Mesothelioma is often caused by asbestos and other carcinogenic mineral fibers.  When these fibers lodge in the pleura, mesothelial cells and macrophages try to phagocytize and eliminate them. However, asbestos is very bio-persistent and cannot be eliminated, which caused cells undergoing programmed necrosis that leads to the release of HMGB1 into the extracellular space.  HMGB1 is a damage-associated molecular pattern molecule (DAMP) that causes inflammation. Asbestos exposure induces HMGB1 release and chronic inflammatory process that overtime may lead to malignancy.  Mesothelioma cells develop out of an environment that is rich in HMGB1 and are often dependent on HMGB1 for their own growth.  In fact, most mesothelioma cells actively secrete HMGB1 extra-cellularly to promote their own tumor growth.  Accordingly HMGB1 levels are high in the serum of mesothelioma patients (reviewed in Yang and Carbone, Clinical Cancer Res 2013).  We tested several anti-inflammatory agents to see if we were able to reduce HMGB1-induced mesothelioma cell growth, and none of them worked except for aspirin, that led us to conduct a series of experiments in vitro and in vivo to test the hypothesis that aspirin inhibits HMGB1 activities, and that by doing so, inhibits mesothelioma growth. Medical Research: What are the main findings? Dr. Yang:  We found that aspirin inhibits the growth of human mesothelioma cells in a xenograft model, moreover in vitro experiments demonstrated that this effects was specifically mediated via inhibition of HMGB1 and not via COX2 inhibition.  We propose that the so far enigmatic anticancer activity of aspirin is mediated, at least partially, via inhibition of HMGB1, and that aspirin may help delay the onset of mesothelioma and may help inhibit the growth of mesothelioma. (more…)
Author Interviews, Heart Disease, JACC / 29.09.2014 Interview with: Katharina Mayer MD Deutsches Herzzentrum München, Technische Universität München, Munich, Germany Medical Research: What are the main findings of the study? Dr. Mayer: Patients whose platelets do not respond well to aspirin carry a higher risk of death or stent thrombosis. Platelet response to aspirin is an independent predictor of ischemic events in patients undergoing percutaneous coronary interventions (PCI). (more…)
Author Interviews, Cancer Research / 19.08.2014

Dr. Mangesh Thorat MBBS, MS(Surgery), DNB(Surgery), MNAMS Centre for Cancer Prevention Wolfson Institute of Preventive Medicine Barts & The London School of Medicine and Dentistry, London EC1M 6BQ Queen Mary University of Londonm Honorary Clinical Lecturer Division of Surgery and Interventional Science Whittington Hospital, Interview with: Dr. Mangesh Thorat MBBS, MS(Surgery), DNB(Surgery), MNAMS Centre for Cancer Prevention Wolfson Institute of Preventive Medicine Barts & The London School of Medicine and Dentistry, London Queen Mary University of Londonm Honorary Clinical Lecturer Division of Surgery and Interventional Science Whittington Hospital, London Medical Research: What are the main findings of the study? Dr. Thorat : Accumulating evidence supports an effect of aspirin in reducing cancer incidence and mortality. Our analyses show that for average-risk individuals aged 50-65y taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15 year period and an overall 4% relative reduction in all deaths over a 20 year period. The benefits of aspirin use would be most visible in the reduction in deaths due to cancer. If the findings of our study are applied to the UK general population aged 50-64 taking aspirin for next 10 years, on an average more than 6000 lives will be saved every year. (more…)
AHA Journals, Author Interviews, Heart Disease, UT Southwestern / 13.08.2014 Interview with: Hurst M. Hall, MD and Sandeep Das, MD, MPH Division of Cardiology University of Texas Southwestern Medical Center Dallas, TX Medical Research: What are the main findings of the study? Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day.  This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns. (more…)