Once you hit 40 or so, you may hear that you should be taking a low dose (75 to 81 mg) of aspirin to help prevent cardiovascular disease (CVD) and colorectal cancer (CRC). It can be tempting to go for it because it’s cheap and prevention seems a whole lot better than treatment, right?
Well, like so much in medicine, it’s complicated. But there’s a new free app that should help you may a more informed decision, and it will certainly prepare you to ask your physician or nurse practitioner better questions about the pros and cons specifically for you.
Even if you’re not that interested in the question of whether you should take low-dose aspirin or not, checking out this app is a good exercise. Most of all, it will help teach you more about the delicate balance that has to be part of almost every decision that you make or that is made for you in health care.
This app is also a great step toward making the decision making process in medicine highly personalized to the individual patient. It helps you identify the specific factors, based on the latest research, that weigh into the decision you and your physician are about to make.
First, some quick background. The U.S. Preventive Services Task Force published a paper in April, 2016 in the Annals of Internal Medicine that recommends taking low-dose aspirin to prevent CVD and CRC if you’re 50 to 59 and have a 10% or greater risk of developing cardiovascular disease in the next 10 years, and aren’t at increased risk for bleeding, among other factors. If you’re 60 to 69, the task force says it’s really an individual decision and the pros and cons are a close call, so they say it depends on whether you place a higher value on the potential benefits or want to avoid potential harms. If you’re 70 or greater, they say there isn’t enough evidence to advise you.
Using the App
So how do you digest all that and make a decision that’s right for you? Two cardiovascular physicians who also specialize in public health from Brigham and Women’s Hospital in Boston and a computer programmer who develops medical apps came together to create the Aspirin-Guide app, available free at the Apple store.
As one of the app developers told a reporter at Science News, “We developed the Aspirin-Guide app because we realized that weighing the risks and benefits of aspirin for individuals who have not had a heart attack or stroke is a complex process. The new mobile app enables individualized benefit to risk assessment in a matter of seconds while the patient is with the physician,” said Samia Mora, MD.
Questions You’ll Be Asked
Technically, the app is designed to help physicians decide, but it will be easy for you to use if you know a few things about yourself:
- Do you have a history of having had a heart attack, chest pain, bypass surgery or a heart stent, a stroke from a blockage in an artery, or peripheral vascular disease?
- Are you hyper-sensitive to aspirin, had bleeding in your gastro-intestinal system, unexplained bleeding, have sever kidney or liver disease, or are taking a blood thinner (anticoagulant or anti-platelet)?
- Your age, race and gender (easiest questions in the app)
- Are you a smoker?
- Do you take medications to lower your blood pressure?
- What is your systolic blood pressure (the “top” number, or the 120 in 120/80)
- Do you have diabetes?
- Do you take a cholesterol-lowering medication?
- What is your total cholesterol level (something like 200 mg/dl, for example)
- What is your HDL cholesterol level (something like 50 mg/dl, for example)
- Do you have atrial fibrillation?
- Do you take an anticoagulant or antiplatlet drug (commonly called blood thinners)
- Have you had a (peptic) ulcer?
- Have you had upper gastrointestinal pain or dyspepsia (painful, difficult, or disturbed digestion, possibly also with symptoms such as nausea and vomiting, and heartburn)
- Do you use NSAID drugs (such as Advil , Aleve, or aspirin, for example) at least 2 to 3 times a week?
- Do you take Prednisone or other oral corticosteroids (not creams).
Digesting the Guidance
After being led step by step through these questions, you are given guidance. Mine, for example, said “Do not advise aspirin.” Yours could be different. But then the app tells you more specifics, explaining whether the harm of taking a low-dose daily aspirin might be greater than the potential benefit.
And then, you can push the button and email the results to yourself, or even to your doctor. Using this app makes me eager to see more tools that will give a wider window for each of us into how to weigh the pros and cons of the many decisions we make about our health every day.