Healthy people taking aspirin to prevent heart attacks could be doing themselves more harm than good, experts have concluded.
The routine use for the prevention of vascular problems “cannot be supported”, UK professors from the Aspirin for Asymptomatic Atherosclerosis (AAA) concluded.
Professor Peter Weissberg, of the British Heart Foundation which part-funded the research, said: “We know that patients with symptoms of artery disease, such as angina, heart attack or stroke, can reduce their risk of further problems by taking a small dose of aspirin each day.
“The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits.”
Reducing the risk of cardiovascular problems had to be set against the increased risk of internal bleeding, the study said.
In patients who have already had a heart attack, the risk of a second is so much higher that the balance is in favour of taking aspirin, Professor Gerry Fowkes, from the Wolfson Unit for Prevention of Peripheral Vascular Diseases in Edinburgh, added.
He wrote: “The benefits of antiplatelet therapy in the prevention of future cardio and cerebrovascular events is well established in patients with a clinical history of arterial vascular disease - however, evidence in primary prevention is limited, with studies suggesting that any benefit of aspirin must be weighed against the risk of bleeding.”
The study, presented at the European Society of Cardiology Congress in Barcelona, recruited 28,980 men and women aged 50 to 75 years who were free of clinically evident cardiovascular disease in central Scotland.
Prof Fowkes added: “It is possible that in the general population, aspirin could produce a smaller reduction in vascular events than this trial was designed to detect, but it is questionable whether such an effect, together with aspirin related morbidity, would justify the additional resources and health care requirements of an ABI (ankle brachial index) screening programme.”
The aim of the trial was to determine the effectiveness of aspirin in preventing events in people with asymptomatic atherosclerosis.
Those entered into the trial were given either a once daily 100 mg aspirin or a placebo.
Major bleeding requiring admission to hospital occurred in 34 (2%) of subjects in the aspirin group and 20 (1.2%) of the placebo group.
Commenting on the results, Professor Fowkes said: “Although the AAA trial was not of screening per se, the results would suggest that using the ABI as a tool to screen individuals free of cardiovascular disease in the community is unlikely to be beneficial if aspirin is the intervention to be used in those found to be at higher risk.
“Other more potent antiplatelets might be considered, but only if increased effectiveness in avoiding ischaemic events is not matched by increased bleeding.”
PA