An Aspirin A Day…Takes Your Sight Away?

amdSRxA’s Word on Health has frequently reported on the health benefits of aspirin.  So we were more than a little shocked to read a new study in JAMA Internal Medicine which suggested that people who regularly use aspirin may be at increased risk of age-related macular degeneration [AMD].  This eye condition is common  among people age 50 and older and is a leading cause of vision loss in older adults.  AMD gradually destroys the macula, the part of the eye that provides the sharp, central vision needed for seeing objects clearly. 

age-related-macular-degeneration1In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disorder progresses faster and may lead to a loss of vision in one or both eyes. The vision loss makes it difficult to recognize faces, drive a car, read, or do close work, such as sewing.

bayer low doseBut don’t go tossing out your Bayer’s just yet!

In this study, researchers at the University of Sydney looked at a large group of  people who took  daily low-dose aspirin as a preventive measure for cardiovascular disease.

Of nearly 2,400 elderly people studied over a 15-year period, 10% were regular aspirin users. Of that group, 25% developed  macular degeneration over that time frame, compared to 9% who developed it but were non-aspirin users.

While these results were statistically significant, more research needs to be done before  recommending that patients stop taking doctor recommended aspirin.   Despite their results, even the researchers admit that there’s just not enough evidence to support stopping aspirin therapy unless a person already has strong risk factors for age-related macular degeneration.

Ophthalmologist Justis Ehlers, MD, agrees, “Aspirin has clearly been shown to have good secondary prevention for different cardiovascular diseasesWe need to sort this out over time to see what it means.

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Fend off a 2nd Heart Attack with Fruit and Fiber

Pills_from_MDEach year, at least 20 million people worldwide survive a heart attack or stroke. Most of them, will then be prescribed a veritable cocktail of drugs including lipid-lowering agents, beta blockers, aspirin, anti-platelet medications, and angiotensin modulators.

In the misguided belief that this polypharmacy will guard against future catastrophic cardiovascular events, many patients think they don’t need to follow a healthy diet.

However a new, 5-year study of almost 32,000 patients in 40 countries showed those who ate a heart-healthy diet rich in fruits, vegetables and fish had an average:

  • 35% reduction in risk for cardiovascular death
  • 14% reduction in risk for new heart attacks
  • 28% reduction in risk for congestive heart failure
  • 19% reduction in risk for stroke

Healthy-Eating-and-Weight-LossResearchers from McMaster University were able to demonstrate, for the first time, that while drug treatments, substantially lower the risk of another heart attack, a high quality diet also significantly lowers the risk.

Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute (PHRI) and his team assessed the association between diet quality and the risk of cardiovascular disease using information collected from men and women who participated in two major McMaster-led global studies: ONTARGET, and TRANSCEND.

Participants with cardiovascular disease were asked how often they consumed milk, vegetables, fruits, grains, fish, nuts, meat and poultry over the past 12 months. They were also asked about lifestyle choices such as alcohol consumption, smoking and exercise. A healthy diet was indicated by a high intake of fruits, vegetables, whole grains and nuts as well as a high intake of fish compared to meat, poultry and eggs.

Clipart Illustration of a Healthy Red Heart Running PastThe results showed that a heart-healthy diet offered a “consistent benefit” over and above the benefits of taking medications to reduce the risk of heart attack and stroke.

Globally, healthy eating was associated with a lower risk of cardiovascular disease by more than 20% in all regions of the world and across all income groups.

Physicians should advise their high-risk patients to improve their diet and eat more vegetables, fruits, grains and fish,” Dehghan said. “This could substantially reduce cardiovascular recurrence beyond drug therapy alone and save lives globally.”

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A Pill to Prevent Skin Cancer?

Summer, it seems, has finally arrived.  And with it comes long lazy days at the beach, the pool… and, unfortunately, the associated risk of skin cancer.  To guard against this we all know to limit sun exposure, use high factor sunscreen and seek shade. But now it seems there’s one more thing we can do to help safeguard ourselves – take Advil!

Really?   Yes, it would appear so.  According to a case-control study published in the journal Cancer, the use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with reduced risk for skin cancer.

Using health registries, researchers identified 18,500 cases of skin cancer among adults in northern Denmark and matched them to population controls without skin cancer. Patients who had ever used NSAIDs (more than two prescriptions) had a 15% reduced risk for squamous cell carcinoma and a 13% reduced risk for malignant melanoma compared with those who had two or fewer prescriptions; especially when the drugs were taken for seven or more years or at a high intensity.

The risk reduction was seen in patients taking aspirin, NSAIDs, and COX-2 inhibitors, such as Celebrex.

Individuals who took NSAIDs did not appear to gain a generally reduced risk from developing basal cell carcinoma, although they had a 15% and 21% reduced risk of developing this kind of cancer on less-exposed sites (areas other than the head or neck) when taken long term or at a high intensity, respectively.

So how do NSAIDs do it?  The authors suggest that they reduce the risk of skin cancer by blocking COX enzymes, which are involved in the inhibition of apoptosis  and in stimulating angiogenesis. Or, in plain English, these anti-inflammatory drugs counteract the enzymes involved in the important steps of cancer development such as inhibition of cell death and suppression of the immune system.

Despite the positive results, lead author Sigrún Alba Johannesdóttir from Aarhus University Hospital cautions, “because there are also risks associated with the use of NSAIDs, we cannot give recommendations on NSAID use in general. It is up to the patient and his or her physician to balance benefits and harms associated with use of the medications.”

Nevertheless, when viewed alongside the study results fom earlier this year that showed patients who took aspirin daily for at least three years were 36% less likely to develop metastatic cancer and 15% less likely to die from the disease, this can only be good news.

Especially for people like me, who love the sun and can’t make it downstairs without a morning dose of diclofenac!

You Can Teach an Old Drug New Tricks

Drug discovery is a laborious process.

From initial discovery of a promising target to the final medication becoming available, is an expensive, and lengthy process. At present, the costs of bringing a single new drug to market is around $1.2 billion, an amount that doubles every five years.

Aside from the cost, it takes, on average, 12 years for an experimental drug to progress from bench through FDA approval to market.

Annually, North American and European pharmaceutical industries invest more than $40 billion to identify and develop new drugs. Even so, for every 5,000 compounds that enter pre-clinical testing, only five, on average, are tested in human trials, and only one of these five receives approval for therapeutic use.

So, it’s hardly surprising that many pharmaceutical companies are choosing to take a closer look at old drugs. Last week, SRxA’s Word on Health brought you news of a host of potential new uses for aspirin.

And aspirin is not alone.  Old drugs often get a surprising second shot at life. In the past few weeks, the news has buzzed about the skin cancer drug – bexarotene – that may cure Alzheimer’s; a common antimalarial drug – hydroxychloroquine – that may help to destroy cancerand, a leukemia drug that inhibits the Ebola virus.

Then, of course, there’s the personal favorite of many women – Latisse.  Originally developed as a glaucoma treatment , it was found to have the desirable side effect of making eyelashes fuller and longer and is now FDA approved for this purpose.

Testing drugs already approved for one use to see if they can treat other conditions, can reduce time and money. Since these known drugs have already undergone toxicology and safety testing, the clinical development program can be streamlined.

Sometimes it’s pure serendipity.

Take Viagra for example. Although these days it’s the stuff of pharmaceutical industry legend , in the early 1990s, it was just a chest pain drug that wasn’t performing very well in clinical trials. So how did the little blue pill go from heart to crotch?  Pfizer was ready to call it quits when they decided to look into one unexpected but common side effect: long-lasting erections. Then came the drug patent and the rest is history.

The discovery that lithium could be used to treat manic episodes in bipolar patients was equally fortuitous. In 1949, Australian psychiatrist John Cade was injecting guinea pigs with urine extracts from schizophrenia patients to try and isolate a compound that caused mental illness. By accident he happened to use a compound with lithium – which at the time was used as a treatment for gout, as the control. Although he didn’t find the compound that caused mental illness, he did find one that treated it!

Back in 2010 we reported on the repurposing of thalidomide. Although the drug caused serious birth defects when it was launched in the 1960’s as a morning sickness pill it has since been found to be useful in reducing severe and frequent bleeding in patients with  hemorrhagic telangiectasia (HHT); in the treatment of patients with newly diagnosed multiple myeloma when taken  in combination with dexamethasone; and for the acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum

The National Institutes of Health (NIH) recently established The Learning Collaborative (TLC) to study how to more easily repurpose known drugs to treat rare forms of blood cancers.

TLC is a dedicated collaboration between the NIH Chemical Genomics Center (NCGC) and its Therapeutics for Rare and Neglected Diseases (TRND) program, The Leukemia & Lymphoma Society (LLS), and Kansas University Cancer Center (KUCC) to discover and develop new drug therapies for rare blood cancers. TLC is creating a pipeline of new therapies to treat leukemia from both the discovery of new treatments as well as identifying new uses for approved and abandoned drugs.  For example, Auranofin, a drug originally used for rheumatoid arthritis, is now in clinical trials for treating chronic lymphocytic leukemia.

Word on Health will continue to follow the drug recycling trend and bring you news as it breaks. In the meantime if you have noticed any beneficial side effects from the medicines you’re taking, we’d love to know.

An aspirin-a-day keeps fat away

Aspirin is one of the most widely used medications in the world. A staggering 40,000 tons of it are consumed each year.

It’s also one of the oldest known medicines. First reports of its use date back to an Egyptian papyrus in 1543 BC. Hippocrates, the father of modern medicine, who lived sometime between 460 BC and 377 BC, left historical records describing the use of powder made from the bark and leaves of the willow tree to alleviate headaches, pains, and fevers. The active ingredient of this willow bark extract – salicylic acid.

In addition to its use as an anti-inflammatory pain reliever, aspirin is also used  as an anticoagulant / antiplatelet agent  to prevent strokes and heart attacks, and to stop coronary and carotid stents from blocking and to prevent deep vein thrombosis associated with long distance travel.

Aspirin has also been theorized to reduce cataract formation in diabetic patients and three studies published last month suggest that taking an aspirin every day may significantly reduce the risk of many cancers and prevent tumors from spreading.

Now, a group of researchers from Canada, Scotland and Australia have discovered that salicylate, the active ingredient in aspirin, directly increases the activity of the protein AMP-activated protein kinase (AMPK).  AMPK is a key player in regulating cell growth and metabolism.  It is considered a cellular fuel-gauge which can be switched on by exercise and the commonly used oral anti-diabetic medication metformin.

We’re finding this old dog of aspirin already knows new tricks,” says McMaster University associate professor of medicine Dr. Greg Steinberg.  The research shows that, in contrast to exercise or metformin which increase AMPK activity by altering the cells energy balance, the effects of salicylate depend on a single amino acid.

Salicylate increases fat burning and reduces liver fat in obese mice which does not occur in genetically modified mice lacking the beta1 subunit of AMPK.

These findings are important as a large clinical trial is currently underway testing whether salsalate (a well-tolerated aspirin derivative), can prevent Type 2 diabetes.  With many recent studies showing that metformin may be important for cancer prevention the authors’ study raise the interesting possibility that aspirin may also be working in a similar manner.

While further studies are needed, the prospect that this cheap, over-the-counter drug can increase fat burning while simultaneously preventing pain, clotting problems and possibly cancer, is probably one of the best health news stories of the year.