When to take (or not take) aspirin to prevent heart trouble

Aspirin, a mild pain reliever, is one of the most familiar medicines in the world. One increasingly common use of this popular medicine, though, may not be s...

Posted: Jan 22, 2019 10:40 AM

Aspirin, a mild pain reliever, is one of the most familiar medicines in the world. One increasingly common use of this popular medicine, though, may not be safe for some older adults, a new analysis of existing research suggests.

People without heart trouble who took a daily low-dose aspirin had a lower risk of heart attack, stroke and death; however, the modest benefits gained were balanced by a major risk, research published Tuesday in the journal JAMA showed. The daily dose increased their risk of bleeding in the gut or in the skull.

"This calls into question the net benefit of taking aspirin, and whether people who have not previously had cardiovascular disease should take aspirin," Dr. Sean Zheng, lead author of the study and an academic clinical fellow in cardiology at King's College Hospital in London, wrote in an email.

Aspirin-a-day is controversial, not recommended for everyone

Low-dose aspirin taken daily is often recommended for people with heart trouble, despite the known risks of gastrointestinal or intracranial bleeding. Scientific studies have shown aspirin's proven benefit in helping prevent a second heart attack or stroke in such high-risk patients.

However, controversy surrounds the use of aspirin to prevent a first heart attack or stroke in low risk patients. The US Preventive Services Task Force, for example, recommends that some older patients without heart trouble take a daily low-dose aspirin, while the European Society of Cardiology does not.

Past clinical trials, some conducted in the 1980s, have shown "conflicting findings," Zheng noted, and since then, the practice of medicine has changed and public awareness of the benefits of exercise and ills of smoking has increased. By including the newest research in its analysis, the new study sought "to provide a more relevant estimate of the benefits and risks of aspirin," he explained.

Data for the analysis came from 13 studies with a combined total of 164,225 participants, all without cardiovascular disease. These studies compared using aspirin versus not using aspirin in people without cardiovascular disease.

Aspirin use was associated with a 0.38% absolute risk reduction for heart attack and stroke and a 0.47% increased absolute risk of major bleeding, the researchers found.

What does this mean in real-world terms?

"For every 265 patients treated with aspirin for 5 years, one heart attack, stroke or death from cardiovascular disease would be prevented," said Zheng, who is a practicing physician. "On the other hand, for every 210 patients treated with aspirin over the same period, one would have a serious bleeding event."

Aspirin also showed no link to premature death for any reason, including a cardiovascular event, and it did not increase the risk of cancer or cancer death, the study found.

The study's findings are not really 'new'

Donna Arnett, past president of the American Heart Association and dean of the College of Public Health at the University of Kentucky, wrote in an email that the "findings aren't really new, but rather, confirmatory of the prior meta-analyses."

Arnett, who was not involved in the study, suggested that patients should discuss with their doctors "their level of risk for a cardiovascular event and determine if there are other interventions that might be more useful, such as quitting smoking or lowering blood pressure or cholesterol levels." She also cautioned that patients with any history of bleeding abnormalities should speak to their physician about using aspirin.

In an editorial, Dr. J. Michael Gaziano, a preventive cardiologist at VA Boston Healthcare System and professor of Medicine at Harvard Medical School, praised the new research as "well conducted." Although the conclusions may not be "new," Zheng's study demonstrates that there is "a general consistency" among both old and the most recent findings.

"When applying these results to an individual patient, clinicians must consider other interventions in addition to aspirin, such as smoking cessation and control of blood pressure and lipid levels, to lower risk," wrote Gaziano, who took no part in the analysis. He noted that "risk is not static" and if patients stop smoking, adopt a healthier lifestyle, and manage their lipids and blood pressure, the risk of a cardiovascular event declines.

"Because weighing the risks and benefits of aspirin in primary prevention is complicated, it should involve a shared decision-making discussion between the patient and the clinician," he said.

Aspirin's benefits as a primary prevention likely overstated

Dr. John McNeil, a professor in the Department of Epidemiology and Preventive Medicine at Monash University's School of Public Health and Preventive Medicine in Australia, said "it is likely" that the new study slightly overstated the benefits of aspirin to prevent a first stroke or heart attack.

This is due to the fact that Zheng and his co-author "averaged trials undertaken 20-30 years ago (which were very favorable to aspirin) with more recent trials which have been substantially less favorable" while also including "four 'unblinded studies' which generally provide less reliable evidence," explained McNeil, who conducted one of the underlying studies, though he did not perform the analysis.

McNeil's own research, the ASPREE trial, looked at the value of taking an aspirin a day to prevent heart attack or stroke in people over the age of 70. "The results were quite unequivocal," he said. "Aspirin confers no overall benefit in this age group and there was a suggestion of net harm."

Other recent studies, McNeil said, "also failed to identify a substantial benefit from aspirin in primary prevention in special groups. Further work is ongoing to determine whether there are any subgroups who might benefit."

Ultimately, McNeilsaid, the new work "provides little support for the widespread use of aspirin for the average person" to prevent a heart attack or stroke, though this is "not to be confused" with the established benefit for at risk patients.

Minnesota Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 37624

Reported Deaths: 1503
CountyConfirmedDeaths
Hennepin12150785
Ramsey4805226
Stearns234519
Dakota228690
Anoka2180107
Nobles16626
Olmsted110115
Washington106940
Mower9452
Rice8357
Scott7004
Clay58538
Kandiyohi5701
Wright4565
Blue Earth4532
Todd4002
Carver3641
Lyon3092
Sherburne3075
Freeborn2900
Steele2281
Watonwan2160
Benton2143
St. Louis17715
Martin1635
Nicollet15912
Cottonwood1340
Goodhue1298
Winona12215
Crow Wing10612
Pine1030
Le Sueur981
Chisago971
Otter Tail931
McLeod880
Carlton850
Dodge840
Polk812
Chippewa781
Unassigned7637
Isanti720
Itasca6412
Waseca640
Douglas620
Meeker611
Morrison591
Murray580
Becker550
Faribault550
Jackson550
Sibley542
Pennington500
Pipestone371
Mille Lacs342
Renville322
Wabasha310
Brown302
Rock300
Yellow Medicine300
Beltrami290
Fillmore280
Houston250
Swift211
Norman200
Wilkin203
Redwood180
Cass152
Wadena150
Aitkin140
Big Stone140
Kanabec141
Koochiching141
Roseau130
Marshall120
Grant100
Lincoln100
Pope100
Mahnomen81
Clearwater70
Hubbard60
Lake60
Traverse50
Lac qui Parle40
Stevens40
Red Lake30
Kittson20
Cook10
Lake of the Woods00

Iowa Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 30975

Reported Deaths: 720
CountyConfirmedDeaths
Polk6464179
Woodbury321544
Black Hawk225258
Buena Vista171111
Johnson12648
Dallas126329
Linn126282
Marshall104319
Scott77810
Story7623
Pottawattamie72111
Wapello70630
Dubuque68322
Crawford6772
Muscatine62944
Sioux4630
Tama46229
Wright3801
Louisa36013
Jasper32317
Plymouth3165
Warren2731
Dickinson2642
Washington2369
Webster2132
Hamilton1871
Cerro Gordo1561
Boone1481
Clay1330
Clarke1312
Allamakee1284
Mahaska11517
Shelby1140
Clinton1071
Poweshiek1048
Carroll961
Pocahontas941
Bremer926
Franklin890
Des Moines882
Henry863
Emmet850
Cedar821
Taylor790
Monona760
Cherokee751
Floyd722
Hardin700
Marion700
Guthrie664
Benton651
Sac630
Jefferson590
Osceola590
Jones560
Humboldt541
Butler532
Harrison530
Lee532
Hancock510
Iowa510
Buchanan501
Monroe506
Calhoun492
Delaware491
Fayette480
Madison452
Clayton433
Lyon410
Palo Alto410
Davis391
Winneshiek380
Grundy370
Mitchell370
Mills360
Howard350
Kossuth340
Lucas304
Greene290
Jackson290
Chickasaw280
Winnebago280
Union270
Ida230
Cass220
Appanoose203
Keokuk201
Page200
Van Buren200
Worth190
Audubon161
Unassigned160
Adair150
Ringgold150
Decatur110
Montgomery102
Wayne100
Adams80
Fremont70
Rochester
Clear
87° wxIcon
Hi: 91° Lo: 68°
Feels Like: 89°
Mason City
Few Clouds
88° wxIcon
Hi: 90° Lo: 68°
Feels Like: 90°
Albert Lea
Clear
88° wxIcon
Hi: 88° Lo: 68°
Feels Like: 90°
Austin
Clear
84° wxIcon
Hi: 90° Lo: 68°
Feels Like: 86°
Charles City
Clear
86° wxIcon
Hi: 88° Lo: 68°
Feels Like: 90°
Hot and sticky fourth of July weekend
KIMT Radar
KIMT Eye in the sky

Latest Video

Image

Alternative baseball hopes to come to the Med City in 2021

Image

FOURTH OF JULY IN AUSTIN AND STEWARTVILLE

Image

Seans 6pm Weather 7/4

Image

Fans excited for Honkers return

Image

Honkers fall to St. Cloud in home opener

Image

Baseball returns to the Med City

Image

Seans 10pm Weather 7/3

Image

Leaders advocate for the homeless

Image

Fireworks Show During the Pandemic

Image

Pillars of the City Unveiled

Community Events