Is Aspirin the Right Treatment for Heart Disease?

A daily dose may not be worth the risk of potential side effects

For decades, aspirin has been used to prevent and treat heart disease, because of its anti-clotting and pain-killing abilities. But according to recent studies, the drug’s risks, including internal bleeding, may not outweigh the benefits for patients without a history of cardiovascular problems such as heart attacks and stroke.

Doctors from Cedars-Sinai Heart Institute pooled the results of nine studies and presented their analysis to the American College of Cardiology showing that daily aspirin therapy is associated with a 10 percent annual reduction in serious cardiovascular events—heart attacks, blood clots, stroke or other fatal cardiovascular complications—but a 47 percent increase in bleeding events, mainly gastrointestinal, that usually require a transfusion or could result in death.

That means that out of every 10,000 patients annually treated with aspirin to prevent cardiovascular disease, six serious vascular events such as non-fatal heart attacks and strokes will be prevented, but at the cost of about three major bleeding events, according to Sanjay Kaul, M.D., director of the Vascular Physiology and Thrombosis Research Laboratory at Cedars-Sinai’s Burns and Allen Research Institute.

In a separate study, University of Edinburgh, Scotland, researchers found that there was no significant reduction in cardiovascular events among 50- to 75-year-olds who took aspirin daily after being identified as having an increased risk of heart attack or stroke. Participants in the study, published March 3 in the Journal of the American Medical Association (JAMA), had no prior history of cardiovascular problems and were taking aspirin with the aim of avoiding a heart attack or stroke.

People without a history of heart disease or stroke should consult their physicians to weigh the potential benefits of taking a daily aspirin against its potential side effects, says Jeffrey Berger, M.D., director of cardiovascular thrombosis at New York University’s Langone Medical Center. Taking aspirin might not be worth it for those with a relatively low risk of cardiovascular disease. If you have one or more risk factors—being older than 50, having high blood pressure or cholesterol, having diabetes or being a smoker—Dr. Berger advises that you talk to your doctor about the best treatment plan for you.

Dr. Kaul recommends that before starting drug therapy, patients with risk factors for cardiovascular disease try modifying their lifestyle through weight reduction, smoking cessation, and controlling blood pressure, cholesterol, and blood sugar, to reduce their risk of heart attack and stroke.

Aspirin’s clearest strength is in secondary prevention, for people who’ve already had a heart attack and want to prevent another. In this case, Dr. Kaul says the benefit of a daily dose of aspirin “vastly exceeds” the risk for side effects. Current research shows that for every 10,000 patients treated with aspirin per year for secondary prevention, 150 serious cardiovascular events—including 34 coronary deaths—will be prevented, at the cost of 19 major bleeding episodes, mainly gastrointestinal, he says.

If you’re already on a daily aspirin regimen, don’t take this new research as signal to abruptly stop your medication, Dr. Berger warns. Stopping a treatment without talking to your doctor can be dangerous and even lead to a heart attack or stroke. “I would really be very careful.”

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