Taking aspirin daily for heart attack or stroke prevention should no longer be recommended for patients who have not experienced either of these events. That's according to a new study published by researchers on the academic site "Family Practice." Almost a quarter of the test subjects over 40 said they took the classic painkiller every day, even if they had no history of heart disease or stroke.
No more aspirin for heart attacks
That's a problem, according to study author Mark Ebell, a researcher at the University of Georgia. “We shouldn’t just assume that everyone will benefit from low-dose aspirin. “The data shows that the potential benefit is similar to the potential harm for most people who have not had a cardiovascular event,” Ebell said. Thirty years ago, aspirin was first found to reduce the risk of fatal and non-fatal heart attacks. Later studies suggested it also reduced the risk of stroke and colon cancer.
According to Ebell, consuming painkillers has always carried risks, namely bleeding in the stomach and brain. So recent studies suggest that potential harm from taking aspirin for a heart attack may outweigh the benefits by today's medical standards.
"If you go back to the 1970s and 1980s, when many of these original studies were done, patients weren't taking statins to control cholesterol, their blood pressure wasn't as well controlled, and they weren't being screened for colon cancer," he said.
Scientific results
Ebell and his colleague Frank Moriarty of the Royal College of Surgeons in Ireland compared studies using patient data from 1978 to 2002 with four large-scale investigations conducted after 2005, when statin therapy and colorectal cancer screenings were more widespread. They found that over five years of treatment in 1,000 patients, there were four fewer cardiovascular events and seven fewer major bleeds. Ebell was particularly alarmed by the number of brain hemorrhages occurring in aspirin users.
“About 1 in 300 people who took aspirin for five years experienced a brain bleed. That's pretty bad. This type of bleeding can be fatal. It can certainly be a deactivation,” he said. “One in 300 is something that the typical doctor cannot pick up in their practice. That’s why we need these large studies to understand small but important increases in risk.”
Ebell cautioned people who are concerned about their cardiovascular risk but have not had a heart attack or stroke. They should talk to their doctors about other options to prevent a major event. These days, he said, theTreatments for blood pressure, cholesterol and diabetesmore aggressive. Rates of other risk factors such as smoking have also fallen. There are so many things we're doing better now to reduce the risk of cardiovascular and colorectal cancer that aspirin helps with that, he said.
The article is “A Comparison Between Contemporary and Older Studies on Aspirin for Primary Prevention.”available online.
