From an apple a day to an app a day, to keep doctor away.

An apple a day keeps a doctor away is common phrase; this phrase has lot interesting stories behind it. Majority of web pages say, initial phrase in 17 the century was actually much different “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread”. But over the period this phrase has taken much different shapes,  In the 19th century, the phrase changed to “an apple a day, no doctor to pay” then  “an apple a day sends the doctor away,”, present phrase i.e. “an apple a day keep doctor away” has come in 1922 onwards. I read a fairy like tale in connection to this phrase, if interested you may read from this link

When I entered medical school as under graduate in late eighties and early nineties, I heard these new phrases instead of  apple, “an aspirin a day keep doctor away” then came “A statin a day keep doctor away” some even went to add ACE inhibitor, omega three fatty acids and least grows.

This new phrase “an App a day keep doctor away” I read in blog post of Kevin Campbell , wherein he discuss present  day apps of smart phones can track our daily activities, our calorie intakes etc thus they work as preventive measures for CV events, so these too can keep doctor away. I think it is nice post I recommend you all to read it.

Now I will discuss about Apple, Asprin and statin

An apple a day keeps doctor away
We know very well, how important are fruits and vegetables in our diet Mediterranean diet rich in fruit and vegetables has shown decreased CV events. Check it from this link

An Asprin a day keep doctor
Asprin a day has shown benefit in secondary prevention, i.e. after the event like heart attack and stroke, but its benefits in general population without events (primary prevention) is not very clear. There is lot concern regarding possible GI bleed with Asprin, these limiting GI bleeds many a times out way the benefits of Asprin. So Asprin for primary preventions as per USPSTF 2009  in summery say, for men it is for prevention of cardiovascular events and for women it is for prevention of stroke. Above age of 80 years no benefit of Asprin in primary prevention. For men above age 45 years and in women it is above age of 55 years Asprin is advised. Read details below

Release Date: March 2009
  1. The USPSTF recommends the use of aspirin for men ages 45 to 79 years when the potential benefit of a reduction in myocardial infarction outweighs the potential harm of an increase in gastrointestinal hemorrhage. Grade: A recommendation.
  2. The USPSTF recommends the use of aspirin for women ages 55 to 79 years when the potential benefit of a reduction in ischemic stroke outweighs the potential harm of an increase in gastrointestinal hemorrhage. Grade: A recommendation.
  3. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of aspirin for cardiovascular disease prevention in men and women age 80 years or older. Grade: I statement.
  4. The USPSTF recommends against the use of aspirin for stroke prevention in women younger than age 55 years and for myocardial infarction prevention in men younger than age 45 years. Grade: D recommendation.

A statin a day keep doctor away
Recent guideline in 2013 recommends statin in preventing CV and stroke events; you may see video below nicely explained by Terry Shaneyfelt

Dr Umesh Bilagi

MBBS, MD, DM (cardiology). I am Interventional cardiologist. Blogging is my passion. Associate professor of cardiology KIMS Hubli. Director and consultant at Tatwadarsha Hospital Hubli. Owner of Jeevan Jyoti Hospital Hubli. Mobile +91 9343403620.

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