Saturday, October 25, 2008

Aspirin Does Not Prevent Heart Attacks in High-Risk Patients

SOURCE: University of Dundee
DUNDEE, United Kingdom -- October 17, 2008 -- Taking regular aspirin and antioxidant supplements does not prevent heart attacks in high-risk groups with diabetes and asymptomatic arterial disease, according to a study published today in the online issue of the [BMJ].
Although there is considerable evidence showing no protective benefit of aspirin in high-risk patients without heart disease, guidelines are inconsistent and aspirin is commonly prescribed for the primary prevention of heart disease in patients with diabetes and with peripheral arterial disease.

Jill Belch, University of Dundee, Dundee, United Kingdom, and colleagues investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease.

The study included 1,276 patients aged over 40 years with diabetes and evidence of artery disease. Patients were randomized to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant, or double placebo. Patients were followed over 8 years.

Overall, the researchers found no benefit from either aspirin or antioxidant treatment in the prevention of heart attacks or death. Patients in the aspirin groups had 116 primary events compared with 117 in the placebo group. No significant difference in events was seen between the antioxidant group and the placebo group.

The authors concluded by voicing their concern at the widespread prescribing of aspirin despite the lack of evidence to support its use in the primary prevention of heart attacks and death in people with diabetes and in view of its possible side effects.

In an accompanying editorial, William Hiatt, Colorado Prevention Center, Denver, Colorado, said: "These findings show that unlike statins and drugs for reducing hypertension, which have a benefit in all risk groups including those with and without heart disease, only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin."

SOURCE: University of Dundee

Interesting study! We have long thought that aspirin was beneficial for prevention of first and future heart attacks, especially for diabetics who have a higher risk of heart and vascular disease. The question is now:
But why not take an aspirin a day? It can't hurt me, can it ???
All medicines may cause side effects, even aspirin. The most common side effects from aspirin include heartburn, nausea and upset stomach. However other reactions can occur and you should seek medical attention right away if any of these SEVERE side effects occur when using aspirin, including:
  • rashes
  • hives
  • itching
  • difficulty breathing
  • tightness in the chest
  • swelling of the mouth, face, lips, or tongue
  • black or bloody stools
  • confusion
  • diarrhea
  • dizziness
  • drowsiness
  • hearing loss and/or ringing in the ears
  • severe or persistent stomach pain
  • unusual bruising
  • vomiting.
This study concludes that "only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin." In other words, regular use of aspirin for prevention of heart disease or stroke in low risk individuals is not helpful and could actually be harmful.
The study also suggests that the use of the cholesterol lowering drugs known as statins benefits all risk groups. I have disagreed with this notion for many years. More info on the cholesterol issue can be found in these past newsletters:

Bottom Line:
If you have diabetes and presently have a low risk of vascular disease, and take aspirin only for prevention, you may consider stopping. Whether this advice holds up for individuals without diabetes will hopefully be in a future study.
We all try to do what is healthy. However what we hear is healthy today, we may hear to be harmful tomorrow. That is why you need a doctor who will take the time keep up with the latest medical information, and weed out the truth from the fiction.
To get a truer overall picture of your health, including reviewing and modifying your individual risk factors, you should schedule a yearly preventive physical.
As Benjamin Franklin once said:

"An ounce of prevention is worth a pound of cure"

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