Regular aspirin may not be good for all: Study

By Dr. Ananya Mandal, MDJan 11 2012

Researchers suggest that healthy individuals who take aspirin to prevent a heart attack or stroke could be doing more harm than good. An analysis of more than 100,000 patients, published in Archives of Internal Medicine, concluded the risk of internal bleeding was too high. The UK-led study said only people with a history of heart problems or stroke should take the tablets. Experts however added that any decision should be made with a doctor.

Aspirin helps people who have had a heart attack or stroke. It prevents blood clots from forming by preventing cells, known as platelets, from sticking together. By reducing the number of clots formed, the tablets reduce the risk of another heart attack or stroke. Some studies have also shown that Aspirin may prevent some cancers, however, the drug is known to increase the chance of internal bleeding, including bleeds on the brain. The debate has been whether at-risk or even healthy people should also take aspirin.

Official guidelines were issued in 2005 by the Joint British Societies, which includes the British Cardiac Society, British Hypertension Society and The Stroke Association. It recommended 75 mg of aspirin a day for high risk patients over the age of 50. The Drugs and Therapeutics Bulletin said in 2008 that preventative aspirin should be abandoned unless there was already evidence of cardiovascular disease.

For these latest analysis researchers looked at data from nine trials, from a total of 102,621 patients. They said that while there was a 20% reduction in non-fatal heart attacks in people taking aspirin, there was no reduction in deaths from heart attack, stroke or cancer. Meanwhile the risk of potentially life threatening internal bleeding increased by 30%.

Lead researcher Prof Kausik Ray, from St George's, University of London, told the BBC, “If you treat 73 people for about six years you will get one of these non-trivial bleeds. If you treat about 160 people for the same period of time, you're preventing one heart attack that probably wouldn't have been fatal anyway. It suggests that the net benefit for aspirin is not there, it certainly doesn't prolong life. If you think about it the net benefit, actually there is net harm.”

The study followed patients for an average of six years. An analysis led by Prof Peter Rothwell, from Oxford University, suggested that regularly taking aspirin reduced the risk of a series of cancers, when patients were followed for much longer. Prof Rothwell said the new study was “very nicely done, but I don't think it develops [the argument] much further”. He added, “It really just emphasizes the need for a more detailed analysis of how risks change over time.”

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said, “Aspirin can help reduce the risk of heart attack or stroke among those with known heart disease, and this group of people should continue to take aspirin as prescribed by their doctor. Our advice is that people who don't have symptomatic or diagnosed heart disease shouldn't take aspirin because the risk of internal bleeding may outweigh the benefits. If you're taking prescribed aspirin and have any concerns, don't simply stop taking it. Always talk to your doctor first.”

A spokesman for the Aspirin Foundation said, “We have had no opportunity to review this new publication in scientific detail. Our first response is that it is at odds with so much existing medical opinion and recommendation that the Foundation will study it fully before any balanced opinion can be expressed.”

Sotiris Antoniou, Consultant Pharmacist in Cardiovascular Medicine at the Royal Pharmaceutical Society, said, “For patients who have been buying aspirin over the counter they should have a discussion with their healthcare professional about whether aspirin is appropriate for them in line with this study.”