Research Recommends Against Routine Use of Aspirin to Prevent Heart Attacks
| A daily aspirin to prevent a heart attack? Not so fast, according to recent research from UAMS. For some people, it may do more harm than good.
For decades, doctors have recommended a daily dose of aspirin to prevent heart attacks, but recent studies have called that into question. UAMS researchers recently collaborated with scientists in the United Kingdom and Egypt for a meta-analysis of the latest science in the field, and their findings provided further evidence for this emerging change in approach.
For the meta-analysis, the researchers took a bird’s eye view of 15 different randomized controlled trails that all looked at this same issue. They used statistical methods to combine and analyze the studies’ results, harnessing the power of data on 165,502 study participants over a follow-up period of 6.4 years.
They found that taking a daily preventive aspirin was associated with a reduction of risk of heart attack, transient ischemic attack (TIA) and ischemic stroke.
However, the use of aspirin was associated with an increase in major bleeding, mainly from the gastrointestinal tract, but also caused brain bleeds, which can be serious.
Preventive aspirin was not associated with a difference in death or in risk of cancer.
“In other words, daily aspirin reduces nonfatal stroke but significantly increases nonfatal bleeding,” said J.L. Mehta, M.D., Ph.D., senior and corresponding study author. “Patients should be aware of this, and the decision to take a daily aspirin should be a discussion between patient and physician. Physicians should tailor their approach based on the patient’s relative risk for cardiovascular events and bleeding events, balanced with their preferences. If they do opt for aspirin, we recommend a low dose of less than 100 mg a day.”
The decision should be a comprehensive discussion rather than a routine recommendation, said Marwan Saad, M.D., a lead author on the study.
“The use of aspirin for primary prevention should be individualized,” Saad said. “Patients who are at high risk for future cardiovascular events but who are also at low risk for these potential bleeding complications may still benefit. For people at greater risk of bleeding, we would probably recommend against using aspirin in this way.”
The study, “Aspirin for the Prevention of Cardiovascular Events,” was published in the Journal of the American College of Cardiology, the premier cardiology journal. Saad and Mehta’s UAMS co-author was Naga Venkata K. Pothineni, M.D., assistant professor in the Division of Cardiovascular Medicine. Saad is a fellow in the Cardiovascular Division of the Department of Internal Medicine in the UAMS College of Medicine. Mehta is a distinguished professor of medicine and physiology and biophysics and the Stebbins Chair in Cardiology.
With the mounting evidence about daily aspirin use, the American Heart Association and American College of Cardiology have developed new guidelines that advise against a routine, blanket use of daily aspirin for preventive purposes. People who have already had a stroke or heart attack or who have undergone heart surgery or stenting should continue to take their medications as prescribed. The change was announced in March 2019.
Mehta said there is more work to be done to determine which patients benefit from aspirin and which do not.
“Today more people are choosing to protect their cardiovascular health with lifestyle modifications, and that may be enough for most people,” Mehta. “Others benefit from other types of cardioprotective medications. Further studies could be done to estimate the risk-benefit ratio of using aspirin for specific sub-groups of the population.”