Aspirin use to ward off heart attacks should be stopped

05 November, 2009

The use of low-dose aspirin to ward off heart attacks and strokes in those yet to develop obvious cardiovascular disease, should be abandoned, says the latest issue of the Drug and Therapeutics Bulletin (DTB).

Low-dose aspirin is widely used to prevent further episodes of cardiovascular disease in people who have already had problems such as a heart attack or stroke. This approach – known as secondary prevention – is well established and of confirmed benefit.

But it is the use of aspirin in primary prevention – for those without symptoms, who have not yet had, for example, a heart attack or stroke, but who may be at risk of doing so – with which DTB takes issue, following an analysis of the available evidence.

In 2000, cardiovascular disease accounted for two million deaths across the European Union alone, and “worldwide, many people take aspirin every day in the belief that doing so helps prevent (cardiovascular disease),” says DTB.

DTB points to various guidelines issued between 2005 and 2008 that recommend aspirin for the primary prevention of cardiovascular disease in various groups of patients. Examples include people aged 50 and older with type 2 diabetes and those with high blood pressure.

But DTB says that current evidence does not back up the routine use of low-dose aspirin in such groups, because of the potential risk of serious gastrointestinal bleeds that accompany its use and the negligible impact it has on curbing death rates.

Doctors should review all patients currently taking low-dose aspirin for primary prevention, either as prescribed or over-the-counter treatment, says DTB. And the decision about whether to continue or stop treatment should be made only after fully informing patients of the available evidence, it says.

“Furthermore, in our view, current evidence makes it hard to recommend starting aspirin for primary prevention,” it adds.

DTB concludes: “… current evidence for primary prevention suggests the benefits and harms of aspirin in this setting may be more finely balanced than previously thought, even in individuals estimated to be at high risk of experiencing cardiovascular events, including those with diabetes or elevated blood pressure.”

“We believe, therefore, that low dose aspirin prophylaxis should not be routinely used for primary prevention.”

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