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A REVIEW OF scientific data on the topic has found that any benefits from taking aspirin to ward off heart disease are slight, and are counterbalanced by a matching rise in bleeding risks.
Aspirin is a blood thinner and can help prevent clots that may lead to heart attack or stroke. But aspirin also boosts the risk of haemorrhage in the brain, stomach and intestines.
“When considering the totality of evidence, cardiovascular benefits associated with aspirin were modest and equally balanced by major bleeding events,” said the report in the Journal of the American Medical Association.
The analysis examined 10 prior studies involving a total of more than 164,000 people with an average age of 62.
Comparing aspirin users to those who don’t take aspirin, researchers found “significant reductions” in strokes, heart attacks and deaths from cardiovascular disease among those who took aspirin.
Aspirin use was also linked to an increased risk of “major bleeding events compared with no aspirin,” it said.
Statistically, the benefits were close to the risks.
If 10,000 people without heart disease took no aspirin for a year, 61 of them would have a heart attack or stroke, explained Kevin McConway, emeritus professor of applied statistics at The Open University.
If 10,000 similar people took aspirin for a year, 57 of them would have a heart attack or stroke.
Downside: bleeding
“Only four fewer in 10,000, but that still has some importance given how common such diseases are and how serious cardiovascular disease is,” said McConway, who was not involved in the study.
Heart disease is the top killer of people worldwide, taking 17.9 million lives around the planet each year, for one-third of all deaths, says the World Health Organisation.
“The downside is the increase in major bleeding events, including bleeding inside the skull and brain or major bleeds in the stomach or gut,” added McConway.
In a non-aspirin-taking pool of 10,000 people, 16 would have such an event in a year, compared to 23 among aspirin-takers.
In other words, about seven more major bleeds annually, which McConway described as a “substantial increase,” even though the annual risk of a haemorrhage “is still not high”.
According to Jeremy Pearson, associate medical director of the British Heart Foundation, the meta-analysis “valuably updates our knowledge, but does not change the current perspective.
“It confirms that the average risk of harm exceeds benefit, so that guidelines should not be changed.”
Aspirin is not recommended in Britain for prevention of heart disease.
But in the United States, the US Preventive Services Task Force recommends “initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years.”
Cancer benefits ‘neutral’
According to a recent nationwide survey of US adults, about half reported regular aspirin use.
Sean Zheng, a cardiologist at King’s College Hospital and lead author of the JAMA report, said the public may not understand that taking low-dose, or baby aspirin, carries significant risks.
“In my opinion, there is no place for routine use of aspirin in patients who are healthy,” he told AFP.
“Maybe it’s because it’s over the counter and it’s described as a baby aspirin, but actually our data show that there is a very real risk, and you shouldn’t take it with the expectation that it’s completely benign and safe.”
The study also delved into aspirin’s preventive benefits when it comes to cancer, and found “no overall association between aspirin use and incident cancer or cancer mortality.”
The review pointed out one study that had found a 15% reduction in cancer death associated with aspirin use after five years of follow-up.
However, the same findings were not replicated in a second trial, which followed almost 500 patients for seven years.
“The findings of this study suggest that the association of aspirin with cancer outcomes is neutral, with no suggestion of harm or benefit from the available current evidence,” said the JAMA report.
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Just a PSA, this is talking about preventative Aspirin, in people who have never had heart disease, or ischaemic stroke/TIA, or peripheral vascular disease. This does not apply to people who have heart disease (stents/bypass surgery/coronary disease on angiogram etc).
The study results also probably don’t apply to patients who are very high risk of heart disease (but haven’t had an event), only low/moderate risk. (Ie you may be on preventative aspirin because you smoke/high blood pressure/family history of premature cardiovascular disease/cholesterol issues/other factors).
Don’t stop your Aspirin without speaking to your doc.
@Peter Wheen: an older doctor put me on aspirin because of my family history. Next time I went, I got a younger doctor, who took me back off it because of the risks of bleeding. It’s a tricky one.
The commen “Aspirin is not recommended in Britain for prevention of heart disease” is inaccurate/misleading. It is not recommended for PRIMARY prevention (ie prevention of heart disease in people who haven’t already had a heart attack), however it IS recommended for secondary prevention. Statements like that in the article might tempt people to stop their aspirin incorrectly.
@Tom Tom: You need to explain what secondary prevention is – It is preventing a further event occuring. This advise is not new. Aspirin is only recommended for established blood vessel disease eg. already had a heart attack, stents for narrow vessels, stroke, arterial leg ulcers etc. If not then the risks of bleeding are greater than the benefit.
@Ranty McCrank: I have been on aspirin for fourteen years and I have never had a heart attack or stroke or any of the other conditions you mention. I do have polycythemia. I think it is also prescribed for haemochromotosis.
Asprin , Statins, wouldn’t touch them with a barge pole for taking over the long term. If you want to be hart healthy cut out sugar and processed carbs, its that easy
@Dave Dublin: Unless you’ve already had a cardiovascular event due to other reasons such as genetics or family history or diabetes etc. It’s never as clearcut as that. The best diet and lifestyle in the world won’t help much if you have a Qrisk of >10%.
@Dave Dublin: dave youve know idea what you’re talking about.keep it to yourself.
@Dave Dublin: THere’s such conflicting opinion regarding statins it is hard what to believe. I know if I had heart disease, and I should do it anyway, I would head onto the plant based diet which has really good evidence – not promoted by the multi trillion dollar tablet dealers.
@Ranty McCrank:
If I were you, instead of self diagnosis of heart disease (how do you do that?) I would head for someone with knowledge of the subject – a medical doctor.
I knew this would come out.
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