September: More on Low Dose Aspirin
In adults aged 50-59 years of age with a 10-year
greater than or equal to 10%, USPSTF recommends initiating
for the primary prevention of
in patients who are not at increased risk of bleeding, have a life expectancy of at least ten years, and are willing to take low-dose aspirin daily for at least 10 years.
In adults aged 60-69 years of age with a 10-year cardiovascular risk greater than or equal to 10%, USPSTF recommends initiating low dose aspirin for the primary prevention of cardiovascular disease and colorectal cancer in patients who are not at increased risk of bleeding, have a life expectancy of at least 10 years, and are willing to take low dose aspirin for at least ten years.
The USPSTF says data are insufficient in adults younger than 50 and older than 70 (but see below!).
By the way, the heart risk calculator used by the USPSTF can be found at
. If you are between the ages of 50 and 70, calculate your 10-year heart risk today to help decide if you should take aspirin for primary prevention of cardiovascular disease and colorectal cancer!
John A. Schmidt, MD
New Data on Primary Prevention with Aspirin in Healthy Persons 70 and Older
The study enrolled community dwelling persons in Australia and the United States who did not have cardiovascular disease,
, or disability. Participants were randomly assigned to receive 100 mg of aspirin or
. In the first part of the study, higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death, a big and disappointing surprise!
In the second part of the study, the authors tested how many patients treated with low dose aspirin or placebo suffered a major
and how many went on to develop cardiovascular disease defined as
atal coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal stroke, or hospitalization for heart failure. Surprisingly and disappointingly, the use of low-dose aspirin resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.
The third part of the study showed that low dose aspirin, as compared to placebo, did not reduce the likelihood of death, dementia, or persistent physical disability.
Conclusion: Primary Prevention with Aspirin for Patients 70 and Older
As a result of the negative and disappointing results published by McNeil, et al., I will no longer recommend low dose aspirin for my healthy patients 70 and older. For patients between the ages of 50 and 70, I will continue to follow the recommendations of the US Prevention Services Task Force, as summarized above.
Immunotherapy for Treatment of Lung Cancer
As discussed in previous newsletters,
is having a major impact on the treatment of cancer.
express a molecule known as
(programmed death ligand 1) which inactivates would-be killer
that block this interaction restore T cell function so they can kill cancer cells more effectively.
Three new studies have now been published online in the New England Journal of Medicine on September 26 showing how such antibodies can be helpful in the treatment of
, the most common fatal cancer in the United States.
In the first study by
Paz-Ares, et al.
, patients with previously untreated metastatic squamous
Non Small Cell Lung Cancer (NSCLC)
with at least 50 percent of the tumor cells expressing PD-L1 were randomized to
alone or chemotherapy supplemented with an anti-PD-L1 monoclonal antibody known as
. The median overall survival was 15.9 months in the combination group versus 11.3 months in the chemotherapy alone group, a modest but highly statistically significant difference.
The second study, conducted by
Horn, et al.
, was similar in design and compared another anti-PD-L1 monoclonal antibody,
in combination with chemotherapy to chemotherapy alone in patients with extensive
Small Cell Lung Cancer (SCLC)
, a much less common and more aggressive form of lung cancer. The median overall survival was 12.3 months in the combination group versus 10.3 months in the chemotherapy alone group, a modest but highly statistically significant difference.
In the third and most important of the three studies, patients with stage III,
unresectable non-small cell lung cancer (NSCLC)
who were previously stable after treatment with radiation and chemotherapy ("
") were randomized to receive yet another anti-PD-L1 monoclonal antibody known as
or placebo. The 24-month survival was 66.3 percent in the durvalu
group, as compared with 55.6 percent in the placebo group. Median progression free survival was 17.2 months in the durvalumab
group and 5.6 months in the placebo group. The median time to death or distant
was 28.3 months in the durvalumab
group and 16.2 months in the placebo group. 15.4 per cent and 9.8 percent of patients discontinued the trial regimen because of adverse side effects in the treatment and placebo groups, respectively.
For cancers that have largely defied medical therapy, these are encouraging results and demonstrate, yet again, that combining modalities is the best way to tame and ultimately defeat cancer. Living with cancer has become a reality. We owe a debt of gratitude to the patients who agreed to participate in these important trials, not knowing if they would be in the treatment or placebo arms of the trial.
Transcatheter Mitral-Valve Repair in Patients with Heart Failure
|Nobel Prize in Medicine is Awarded to Two Cancer Immunotherapy Researchers
As reported in the New York Times on October 1, The Nobel Prize in Physiology or Medicine was awarded to James P. Allison of the United States and Tasuku Honjo of Japan for their work on unleashing the body's immune system to attack cancer, a breakthrough that has led to an entirely new class of drugs and brought lasting remissions to many patients who had run out of options. You can watch the announcement here.
Medicare Part D Open Enrollment
All Medicare patients are required by law to purchase medication coverage (Part D). Unfortunately, many of my Medicare patients opt for cheap plans and then end up paying large out-of-pocket sums for the medicines they deserve. October 15th marks the beginning of Medicare Open Enrollment. I advise all Medicare recipients to visit
and click on the part D tab. Enter your zip code and medications and sign-up for the plan that best meets your needs and your pocketbook!
Our oldest doctor daughter and her wonderful physician husband are expecting their third child and our sixth grandchild within the month!! Our fifth grandchild just turned two months old and is fabulous!
Valerie, Stephanie, Ms. Clark, Ms. Catong, Ms. Sentner, and I wish you a wonderful autumn season full of color and spice!
Board Certified Internist
Dr. Schmidt is one of the leading internists in Monmouth County offering
He is an attending physician at Jersey Shore University Medical Center.
Dr. Schmidt is enrolled in the Maintenance of Certification Program of the American Board of Internal Medicine
Feel free to share this newsletter with your family and friends.
Register to receive our monthly newsletter
Click here to learn more about the benefits of our
Follow My Health Patient Portal
and register today! You can make appointments and get your lab results on the portal. Simply ask Valerie to send you an invitation. Call 732-282-8166.
"Notice that autumn is more the season of the soul than of nature."
- Friedrich Nietzsche