Routine aspirin benefits queried

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http://news.bbc.co.uk/1/hi/health/8072215.stm

 

Low-dose aspirin should not routinely be used to prevent heart attacks and

strokes, contrary to official guidance, say UK researchers.

 

Analysis of data from over 100,000 clinical trial participants found the risk of

harm largely cancelled out the benefits of taking the drug.

 

Only those who have already had a heart attack or stroke should be advised to

take a daily aspirin, they found.

 

The study should help clarify a " confusing " issue, a leading GP said.

 

The NHS drugs watchdog, the National Institute for health and Clinical

Excellence (NICE), has not made a ruling in this area.

 

But experts in the UK, US and Europe recommend aspirin for people who have not

already had a heart attack or stroke, but are at high risk of cardiovascular

disease because of factors such as age, blood pressure and cholesterol level.

 

This strategy, known as primary prevention, is based on the result of studies

looking at predicted risks and benefits in this population.

 

But the latest research is provides clearer evidence because it is based on data

from individuals, the researchers said.

 

They looked at heart attacks and strokes and major bleeds - a potential side

effect of aspirin - in six primary prevention trials, involving 95,000 people at

low to average risk and 16 trials involving 17,000 people at high risk - because

they had already had a heart attack or stroke.

 

Use of aspirin in the lower-risk group was found to reduce non-fatal heart

attacks by around a fifth, with no difference in the risk of stroke or deaths

from vascular causes.

 

But it also increased the risk of internal bleeding by around a third.

 

Balance

 

However, in those patients who had already had a heart attack or stroke and were

at risk of having another, the benefits clearly outweighed the chance of adverse

events, the researchers said.

 

Study leader Professor Colin Baigent from the Clinical Trial Service Unit at the

University of Oxford, UK, said drug safety was vital when making recommendations

that affected tens of millions of healthy people.

 

" We don't have good evidence that, for healthy people, the benefits of long-term

aspirin exceed the risks by an appropriate margin. "

 

He added: " I think the guideline groups will find it useful to have the data

analysed in that way. "

 

Professor Steve Field, chair of the Royal College of GPs, said the issue had

been confusing for GPs and patients.

 

" There is no definitive guidance and it makes it bewildering when you have a

series of papers which then hint it would be beneficial to take aspirin. "

 

He added that many patients would buy aspirin over the counter - either on the

advice of their GP or under their own steam - because it was cheap.

 

" This important study does suggest people shouldn't take aspirin unless

indicated by disease. "

 

Ellen Mason, senior cardiac nurse at the British Heart Foundation said: " It is

better for doctors to weigh up the benefit and risk of prescribing aspirin on an

individual basis, rather than develop a blanket guideline suggesting everyone at

risk of heart disease is routinely given aspirin. "

 

 

 

 

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