Aspirin not likely to extend life in people without heart disease

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A regular, low dose of aspirin has long been thought to be an effective preventive measure against heart attack and stroke, but a large new analysis of data from several clinical trials suggests that reductions in mortality extend only to people with a history of cardiovascular disease. In fact, as the authors of the new study report in the Archives of Internal Medicine, a routine dose of aspirin significantly raises a person s risk of internal bleeding.

In order to gain a better picture of the risks and benefits conferred by a regular aspirin regimen among patients without a history of
heart disease, researchers led by a specialist in cardiovascular disease prevention at St. George s University of London analyzed data from nine clinical trials totaling over 100,000 healthy people, half of whom took aspirin for an average of six years, and half of whom took a placebo. The treatment group took aspirin either daily or every other day, a schedule aimed at preventing clots in blood vessels that can lead to heart attack and stroke.

While the researchers did note a 10 percent reduction in non-fatal heart attacks among aspirin users, this modest benefit was countered by a 30 percent increase in the risk of serious internal bleeding. Furthermore, there was no significant reduction in the incidence of fatal or non-fatal stroke, death from heart attack, or cancer.

Given these results, the researchers concluded that the benefits of aspirin in primary prevention that is, in people without a history of cardiovascular disease are not enough to outweigh the risk of internal bleeding. Treatment decisions, they say, should be made on a case-by-case basis, taking into account a patient s known risk of cardiovascular disease. Currently, a regimen of aspirin is still recommended for individuals who have already suffered a heart attack or stroke or have been diagnosed with cardiovascular disease (secondary prevention).

This is a very important finding, says ACSH s Dr. Gilbert Ross. Since so many people take aspirin as a primary preventive measure, these findings should spur doctors to take a careful look at a patient s risk profile before recommending aspirin as a preventive agent for heart attack.