Low-Dose Aspirin to Prevent First Heart Attack or Stroke? Not So Fast

Modest benefits might not outweigh bleeding risk, evidence review suggests

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Monday, January 9, 2012

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MONDAY, Jan. 9 (HealthDay News) -- For years, people have been told that low-dose aspirin can help reduce their risk of dying from a heart attack, stroke or cancer even if they are healthy. Now, a new evidence review calls this advice into question.
Low-dose daily aspirin therapy does not reduce risk of dying from cardiovascular disease or cancer, according to a new study in the Jan. 9 online edition of the Archives of Internal Medicine. However, experts not affiliated with the study caution that there is not a simple one-size-fits-all answer, and that anyone currently taking low-dose aspirin to reduce their risk for a first heart attack or stroke should talk to their doctor before they stop.
The analysis conducted by researchers in the United Kingdom included nine studies and more than 102,000 participants who were followed for about six years. Daily low-dose aspirin resulted in a 10 percent reduction in heart attack or stroke, mainly driven by a reduction in nonfatal heart attacks. There was no reduction in death from heart disease, stroke or cancer seen among people taking low-dose aspirin. And the review confirmed aspirin's risk for serious bleeding events.
The study only looked at aspirin as primary prevention -- preventing a first heart attack or stroke. By contrast, secondary prevention refers to staving off a recurrence or worsening of a preexisting condition such as heart attack or stroke. Individuals should still take low-dose aspirin for secondary prevention, the authors and outside experts agree.
"Taken in the aggregate, the modest benefit of aspirin on patients without established cardiovascular disease has to be carefully balanced against the excess risk caused by the therapy," said Dr. Jeffrey Berger, director of cardiovascular thrombosis at NYU Langone Medical Center in New York City. "Because aspirin is an over-the-counter drug, widely available and inexpensive, people assume there is really very little risk, and while the risk is small, the benefit in a lower-risk population is not as great as we once thought."
It comes down to weighing your risks versus your benefits, explained Berger, who was not part of the study team.
American Heart Association spokesperson Dr. Nieca Goldberg, medical director of the Women's Heart Program at the NYU Langone Medical Center, agreed.
"It is very important [for patients] to talk to their doctor about whether or not [aspirin] is appropriate," she said. "If you have heart disease, prior heart surgery or chronic chest pain due to clogged arteries, this study is not about you," Goldberg stressed.
"Some people may have heart problems they don't know about or multiple risk factors where the risk of bleeding may not outweigh the benefit, so they need to work with their doctor to get this straight," Goldberg said. "Heart disease risk factors include high blood pressure, high cholesterol, diabetes, obesity, [being] poor, family history of heart disease and smoking. These can add up and place an otherwise healthy individual at moderate or elevated risk for heart disease."
Also commenting on the study, Dr. Stephen Kopecky, a cardiologist at the Mayo Clinic in Rochester, Minn. and president-elect of the American Society for Preventive Cardiology, said that the decision to start taking low-dose aspirin as primary prevention is highly individualized. But if you are already taking low-dose aspirin as primary prevention, he said, "do not stop. Talk to your doctor and at least go over the pros and cons."
Dr. Samia Mora, a cardiologist at Brigham and Women's Hospital in Boston, wrote a journal editorial accompanying the new study. "For individuals without evidence of heart or vascular disease, it is an individualized decision that should be discussed with their physician or health care provider since it is a matter of weighing the risks and benefits of taking aspirin," she said.
"For healthy individuals who are at low risk for developing heart or vascular disease, there is generally little benefit from routine aspirin use," Mora pointed out.
Goldberg added: "Aspirin is so readily available and people watch commercials about how it has saved a person's life, and go to the drug store and think 'this could save my life,' but they may not have the same situation as people in the TV commercials."

SOURCES: Jeffrey S. Berger, M.D., director, cardiovascular thrombosis, NYU Langone Medical Center, New York City; Stephen Kopecky, M.D., cardiologist, Mayo Clinic, Rochester, Minn.; Nieca Goldberg, M.D., medical director, Women's Heart Program, NYU Langone Medical Center, New York City; Samia Mora, M.D., cardiologist, Brigham and Women's Hospital, Boston; Jan. 9, 2012, Archives of Internal Medicine, online

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