17/10/2008

Aspirin 'Doesn't Prevent Heart Attacks'

Despite GPs prescribing the drugs to many thousands of their patients by way of prevention, new research suggests that aspirin does not after all prevent heart attacks.

Taking regular aspirin and antioxidant supplements does not prevent heart attacks even in high risk groups with diabetes and asymptomatic arterial disease, and aspirin should only be given to patients with established heart disease, stroke or limb arterial disease, according to a study published by bmj.com.

In light of these findings, and the evidence from six other well controlled trials, the prescribing practice of doctors and international guidelines should be reviewed so that aspirin is only prescribed to patients with established heart and stroke disease, argues the author of an accompanying editorial.

Patients with diabetes are two to five times more likely to suffer from heart disease than the general population and heart disease is a major cause of death in patients with type 1 and 2 diabetes.

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.

But aspirin is one of the top 10 causes of adverse drug events reported to the Commission on Human Medicines.

It causes gastrointestinal bleeding and the risk of bleeding increases with age and prolonged use.

Professor Jill Belch and colleagues from Scotland investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease.

They said that 1,276 patients with diabetes and evidence of artery disease over 40 years of age were randomised to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant or double placebo, and followed over eight 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.

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, writes Professor William Hiatt in an accompanying editorial.

(BMcC)

Related UK National News Stories
Click here for the latest headlines.

29 May 2009
Widespread Use Of Aspirin Slammed
A new study in The Lancet medical journal has found that healthy people who take aspirin reduced their already small risk of heart attack or stroke by just 12%. However, the small risk of internal bleeding increased by a third.
13 April 2005
New research highlights possible health benefits of aspirin for over-50s
People aged over 50 could benefit from taking a dose of aspirin every day, new research has claimed. The research, conducted by the College of Medicine at Cardiff University, has suggests that one in four heart attacks and strokes could be prevented if those aged fifty and over took aspirin every day.
09 April 2015
Shorter People More At Risk Of Heart Disease
Shorter people are more at risk of coronary heart disease, according to a new study led by Professor Sir Nilesh Samani, British Heart Foundation Professor of Cardiology and Head of the Department of Cardiovascular Sciences. The research discovered that every 2.5 inches of change in height affects the risk of coronary heart disease by 13.5%.
20 May 2005
Benefits of aspirin for over-70s questioned
Questions have been raised over the benefits of giving low dose aspirin to healthy people aged 70 and over. A study published by the British Medical Journal (BMJ) suggested that the benefits of giving aspirin to the over-70s could be offset by increased cases of serious bleeding.
16 June 2004
NHS makes 'constant improvement' in heart attack treatment
Hospital care for patients in England and Wales who have had a heart attack is constantly improving, according to an audit carried out by the Royal College of Physicians (RCP).