The new aspirin guidelines: The media does a disservice to patients

Much media attention has been paid to the new guidelines from American College of Cardiology/American Heart Association (ACC/AHA) on the primary prevention of cardiovascular disease. Based on new clinical trial data, ACC/AHA no longer recommends that healthy adults without cardiovascular disease — emphasis on without cardiovascular disease — take daily aspirin for the primary prevention of cardiovascular disease.

This change, while significant, is highly nuanced and dependent on a clear understanding of the difference between primary prevention and secondary prevention. Primary prevention is the sum of efforts to prevent an event that an individual has never had in the past. An example of primary prevention is administration of vaccines, which help protect against contracting a disease in the first place. Secondary prevention involves reducing the impact of current diseases and seeking to prevent future recurrences of events that have already occurred. Quitting smoking after being diagnosed with chronic obstructive pulmonary disease (COPD) and completing cardiac rehabilitation after having a heart attack represent common examples of secondary prevention.

The new ACC/AHA guidelines address the primary prevention of cardiovascular disease in individuals currently without cardiovascular disease. For decades, the prevailing notion was that a low-dose aspirin may prevent cardiovascular disease before it begins. However, recent large randomized trials have shown this perceived benefit to be negligible while increasing the risk of a serious bleeding event. This was true even in individuals with diabetes who have an inherently higher risk for cardiovascular disease. Based on this new evidence, low-dose aspirin is no longer recommended for primary prevention in individuals at low risk for cardiovascular disease, adults older than age 70, or individuals at increased risk of bleeding.

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Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive systems (vaginauterus, and ovaries) and the breasts. Outside medicine, the term means "the science of women". Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.

Almost all modern gynaecologists are also obstetricians (see obstetrics and gynaecology). In many areas, the specialities of gynaecology and obstetrics overlap.



In some countries, women must first see a general practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynaecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynaecologist. In the United States, however, law and many health insurance plans allow gynaecologists to provide primary care in addition to aspects of their own specialty. With this option available, some women opt to see a gynaecological surgeon for non-gynaecological problems without another physician's referral.

As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is quite intimate, more so than a routine physical exam. It also requires unique instrumentation such as the speculum. The speculum consists of two hinged blades of concave metal or plastic which are used to retract the tissues of the vagina and permit examination of the cervix, the lower part of the uterus located within the upper portion of the vagina. Gynaecologists typically do a bimanual examination (one hand on the abdomen and one or two fingers in the vagina) to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do a rectovaginal examination for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynaecologists may have a female chaperonefor their examination. An abdominal or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient's history.

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