NLM Director’s Comments Transcript
Aspirin: Initial Heart Attack and Stroke: 01/26/2015

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Aspiring and heart disease poster with portrait of a senior.

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff U.S. National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

A daily, low dose aspirin may not prevent heart attacks, strokes as well as some other heart disease related conditions for older adults, suggests a comprehensive Japanese study and an accompanying editorial recently published in theJournal of the American Medical Association.

A randomized clinical trial of 14,464 patients who participated in the Japanese Primary Prevention Project (JPPP) compared adults age 60 or older (who randomly received one daily, low dose aspirin) to a group that did not take aspirin. Although none of the study’s participants had a prior heart attack or stroke, all were diagnosed with high blood pressure, diabetes, or high fat/cholesterol levels in their blood. The study’s authors noted the latter conditions increased the risks of a heart attack and a stroke for all participants.

The study’s 11 authors explain prior to this research, all the study’s participants might have been considered candidates for a low dose aspirin in order to prevent stroke, heart attacks, and related cardiovascular events from initially occurring.

However, the Japanese researchers stopped the study (which was expected to last for six and half years) in its fifth year because no statistically significant differences in non-fatal heart attacks and other related conditions were reported between the two groups.

After five years, the study’s authors reported 20 participants who received aspirin experienced a nonfatal heart attack compared to 38 persons who did not receive aspirin.

Similarly, the study found no significant differences in preventing nonfatal strokes and fatal cardiovascular events between the aspirin and non-aspirin groups. Overall, about 2.7 percent of the participants who took daily low dose aspirin had a heart attack, stroke, or other heart disease-related event compared to 2.9 percent among those who did not take aspirin.

The two authors of an editorial that accompanied the study write (and we quote): ‘The JPPP study adds to the body of evidence that helps refine the answer to the question of when aspirin should be used to prevent vascular events’ (end of quote).

However, the editorial’s authors (who include JAMA’s senior editor) conclude the study suggests (and we quote) ‘patients at very low risks of vascular events should not take aspirin for prevention of vascular events, even at low dose’ (end of quote).

The editorial’s authors note the study’s overall findings fail to challenge or counter existing research that suggests aspirin helps prevent against a second heart attack, stroke, or other cardiovascular illnesses -- or aspirin is therapeutic for adults at a high immediate risk of a heart attack or stroke. The editorial’s authors write (and we quote): ‘aspirin is indicated for patients at high-short-term risk due to an acute vascular event and those undergoing certain vascular procedures; patients with any evidence of vascular disease should be given daily aspirin’ (end of quote).

Ironically, the editorial’s authors explain after a century of use, the evidence about aspirin’s optimal use is still emerging. They write (and we quote): ‘the balance between benefit in preventing major vascular events and the risk of increasing serious bleeding…underlies the clinical decision of when to use this inexpensive generic drug’ (end of quote).

Meanwhile, MedlinePlus.gov’s heart attack health topic page provides links to two websites that provide insights into taking aspirin to prevent initial or repeated heart disease and stroke. A website from the U.S. Food and Drug Administration (available in MedlinePlus.gov’s heart attack health topic page’s ‘prevention/screening’ section) provides basic information about taking aspirin to reduce the risk of heart attack, heart conditions, and stroke.

A website from the U.S. Office of Disease Prevention and Health Promotion (also available in the ‘prevention/screening’ section of MedlinePlus.gov’s heart attack health topic page) adds tips on talking to a physician about taking aspirin daily.

MedlinePlus.gov’s heart attack health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about heart attacks as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s heart attack health topic page, type ‘heart attack’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Heart attack (National Library of Medicine).’ MedlinePlus.gov also has health topic pages devoted to heart disease and vascular (or blood system) diseases. There is specific information about aspirin’s safety within the ‘drugs & supplements’ section, which is accessible on MedlinePlus.gov’s home page.

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