Aspirin not to be routinely taken by the healthy
posted in - Health tips, - Medical Updates, - Palmdoc |I have seen local community forums where lay persons are advising others to take aspirin like “multivitamins” to prevent strokes and heart attacks. We do not have sound evidence for doing so in the healthy population. In fact indiscriminately popping low dose aspirin would probably result in seeing more bleeding complications. Recent research from Britain shows that Aspirin does more harm than good in healthy people
At a conference for leading doctors, British scientists said they have found that for healthy people taking aspirin does not significantly reduce the risk of a heart attack. At the same time they found it almost doubles the risk of being admitted to hospital due to internal bleeding.
The findings show that for otherwise healthy people the risks of taking aspirin outweigh the benefits. The doctors stressed that patients who had already suffered a heart attack should continue to take the drug.
Aspirin is not the same as warfarin and is not the same as panadol.
The effects of NSAIDs (aspirin, voltaren, ibuprofen etc) on platelets are not the same as that of COX-II inhibitors (arcoxia, celebrex) and the effect probably is not the same within the same class
I see some GPs recommending low dose aspirin in all patients with uncomplicated hypertension but who have not had a heart attack, no other risk factors for CAD and I don’t quite agree with this practice.
Primary Prevention means preventing something from happening in the first place,. So giving low dose aspirin for the primary prevention of heart attacks means using it for people who have not had heart attacks before (and who are also asymptomatic and do not have any coronary artery disease).
Secondary prevention means giving it after it has occurred to prevent the risk of second and subsequent heart attacks.
The use of low dose aspirin is established for the Secondary prevention of heart attacks and ischaemic strokes.
The evidence for the use of low aspirin in the setting of Primary prevention is more contentious
The AHA did spell out some guidelines and perhaps some doctors may prescribe low dose aspirin for people “at higher risk” of heart attacks, in conjunction with other measures you can take for reducing risks
See this link from the American Heart Association for more info
Regarding aspirin from that link:
Goal: Low-dose aspirin in people at higher risk of coronary heart disease (especially those with a 10-year CHD risk of 10 percent or greater).
Recommendations
* Do not recommend for patients with aspirin intolerance (or allergy).
* Low-dose aspirin increases risk for gastrointestinal bleeding and hemorrhagic stroke. Do not use in people at increased risk for these diseases.
* Benefits of reducing cardiovascular risk outweigh these risks in most patients with higher coronary risk.
* Doses of 75–160 mg per day are as effective as higher doses. Consider 75–160 mg aspirin per day for people at higher risk (especially those with a 10-year CHD risk of 10 percent or greater).
If you want to assess your 10 year CHD risk, you can use this calculator
The AHA guidelines may recommend low dose aspirin in diabetics for primary prevention but even the latest data suggests there may be no benefit (see MedPageToday; we mentioned this also in Routine aspirin use questionable in diabetics)
So the bottom line is, the evidence for low dose aspirin in Primary prevention is still somewhat unclear.
There are risks involved with taking low dose aspirin and if you want to take it, you should be clear that the benefits outweigh the risks.
The above information is provided for educational purposes and you have to consult your doctor for specific advice.
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September 2nd, 2009 at 2:03 pm
The ARRIVE study specifically addresses this issue, iianm.
But for moderate-risk rather than those at low-risk.
http://www.arrive-study.com/EN/
“The ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events) trial is one of the largest clinical studies ever conducted in a population at moderate risk of initial events associated with cardiovascular and cerebrovascular disease (CVD). ARRIVE will expand the already existing, strong body of evidence supporting use of Aspirin for primary prevention of events associated with CVD”