Should You Take Aspirin to Prevent Heart Disease?
It you are among the millions of Americans who take low-dose aspirin every day because you have been told that you are safeguarding yourself against heart disease, a new meta-analysis indicates that the benefits are minimal and that the risks may be greater.
Current recommendations from the American Heart Association are for patients to take aspirin if they have had a heart attack, unstable angina, ischemic stroke, or transient ischemic attacks, if not contraindicated. The AHA website notes that “this recommendation is based on sound evidence from clinical trials showing that aspirin helps prevent the recurrence of such events as heart attack, hospitalization for recurrent angina, second strokes, etc.” The AHA also notes that “Studies show aspirin also helps prevent these events from occurring in people at high risk (primary prevention).”
New study results released by scientists from the Cedars-Sinai Heart Institute and presented at the American College of Cardiology’s Scientific Session in Atlanta caution that routine aspirin use does not result in a significant reduction in serious cardiovascular events in either men or women, and that it is associated with a risk of internal bleeding. The finding comes after researchers evaluated nine trials that included more than 104,000 patients.
This new study is not the first to challenge or question the benefits and/or risks associated with daily aspirin use for preventing cardiovascular events among people with a history of such events as well as otherwise healthy people who are at risk for heart attack or stroke. In a 2009 study published in Lancet, a team from the United Kingdom found that individuals who are at increased risk for heart disease are also at increased risk for bleeding associated with aspirin use.
In the Lancet study, the investigators evaluated 22 studies that included approximately 112,000 patients at low to high risk for cardiovascular disease. They found that daily use of aspirin was associated with an increased risk for internal bleeding by one-third of people in the low-to-average risk group of patients, and that in all patients, aspirin reduced the risk of nonfatal heart attacks by about 20 percent.
Overall, the Lancet study showed that aspirin prevented five nonfatal heart attacks for every 10,000 low-to-moderate risk patients who were treated, and that one additional bleeding-related stroke and three additional stomach bleeds occurred in this group. The study’s lead author, Colin Baigent, an epidemiologist from the University of Oxford, stated that “On the basis of these findings, we don’t believe that general guidelines advocating the routine use of aspirin in healthy people can be justified.”
The new Cedars-Sinai study supports the Lancet findings. According to Sanjay Kaul, MD, director of the Vascular Physiology and Thrombosis Research Laboratory at the Burns and Allen Research Institute at Cedars-Sinai, “The results of this study challenge current guidelines regarding aspirin use for cardiovascular disease prevention.”
American Heart Association
Baigent C et al. Lancet 2009 May 30: 373(9678): 1849-60
Cedars-Sinai Medical Center