For and against Aspirin for everyone older than 50?Current population screening for vascular disease is neither efficient nor effective. Peter Elwood and colleagues believe we should have a public information strategy highlighting the benefits (and risks) of aspirin for older people, but Colin Baigent argues that the evidence of benefit is not yet strong enough FORIt is 30 years since the first randomised trial was published showing a link between aspirin and myocardial infarction. 1 We believe that the evidence now supports more widespread use of aspirin prophylaxis, and there needs to be a strategy to inform the public and enable older people to make their own decision. The evidence focuses on a crucial question-namely, at what age does the balance between benefit and risk justify low dose aspirin prophylaxis? Of further relevance is a possible reduction of cancer and dementia by aspirin. Recommendations for aspirin prophylaxisAlthough several groups have recommended aspirin prophylaxis based on age alone, including a recommendation of daily aspirin for everyone over 50, 2 3 cardioprotection is usually given only to people at vascular risk. Many formulas are available to assess risk, and one of these 4 is the basis of the recommendation that prophylactic aspirin be considered if the five year risk of a vascular event is 3% or more. Risk of undesirable effectsAspirin is inappropriate for people with known contraindications. At low dose, however, undesirable effects are unusual and seldom serious, 8 and probably 90-95% of the population could take low dose aspirin without problems. The advice that people without symptoms should consult a doctor before starting aspirin prophylaxis is unreasonable and places the doctor in an impossible position. Without symptoms or a history suggestive of a contraindication, undesirable effects cannot be predicted. Each person, not a doctor, should evaluate the risks and benefits. A heart attack or stroke has serious physical and psychological effects as well as effects on the family, work colleagues, and friends. Most older people know this from experience and many will dread a vascular event. They are likely to accept a small increased risk of bleed or other side effect in exchange for a reduced risk of a heart attack or stroke. using baseline values of total cholesterol, high density lipoprotein cholesterol, and systolic blood pressure. Men who had had a stroke (17) or a myocardial infarction (246) before the study period were excluded. †Results in women were obtained by the application of the Framingham formula to grouped data for 550 women in the Heart Beat Wales survey. 7 Evidence on previous vascular events was not available.
This article describes an outbreak of Q fever involving 24 men (five prison officers and nineteen detainees) in one of H.M. Detention Centres. The evidence collected points strongly to the consumption of raw milk as the route of infection. This appears to be the first milk-borne outbreak of Q fever to be reported in Britain.
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