Can daily aspirin stop heart attacks?

Middle-aged men and women should take aspirin daily to prevent heart attacks, media reports suggest.

UK researchers found men from the age of 48 and women aged 58 and over were at risk of developing CHD, suggesting everyone in these groups would benefit from the drug.

The role of aspirin for secondary prevention of CHD is already well established, with GPs routinely prescribing it to patients who have already suffered a heart attack or a stroke.

But the researchers warn that aspirin should not be prescribed to patients who suffer from stomach ulcers or have a history of GI bleeding.

What is the research?
The findings are based on a study of 12,000 patients selected from 304 general practices throughout England and Wales.

Patients were eligible for the study if they had no history of CHD and diabetes, had not been prescribed any lipid lowering drugs and were aged between 30 and 74 years old.

The researchers used the Joint British Societies (JBS2) cardiovascular risk calculator, which uses seven risk factors (age, sex, systolic or diastolic BP, smoking status, diabetes status, total and HDL cholesterol) to calculate CHD risk in the patients.

They then used mathematical modelling to establish the average age at which men and women moved from a low risk of CHD, below 10 per cent, to a high risk, greater than 10 per cent.

These thresholds were based on 10-year CHD risk estimates developed by the American Heart Association to identify the point at which the cardio-protective benefit of aspirin therapy outweighs the risk of bleeding. The researchers found that the average 10-year CHD risk in the population was 9 per cent (11 per cent for men and 7 per cent for women).

Risk increased with age and the transition from low to high risk occurred at 47.8 years for men and 57.3 years for women.

What do the researchers say?
Lead researcher Dr Iskandar Idris, consultant physician in diabetes and endocrinology and senior lecturer at the University of Sheffield, said: 'Our findings suggest that most men over the age of 48 years and women over 57 years would benefit from aspirin.

'They should routinely be considered for aspirin therapy since for most of them, their 10-year CHD risks are high enough.'

However, as is the case for most population studies, not all patients above the age thresholds would necessarily benefit, warned Dr Idris.

The final decision to start aspirin should therefore be made following discussions with their respective healthcare providers, he said.

'GPs should not prescribe aspirin to patients with a history of bleeding, on warfarin therapy with a history of gastritis and stomach ulcers or uncontrolled hypertension, unless significant discussion about risk benefits are presented to patients,' he added.

What do other researchers say?
Wigan GP Dr Mike Knapton, director of prevention and care at the British Heart Foundation, warned of 'both benefits and risks associated with taking aspirin daily as a preventative measure'.

'Further robust research is needed before aspirin should be considered as a blanket primary prevention measure in the UK.

'We would encourage everyone to examine their own risk and take steps to reduce it by adjusting their lifestyle.'

sanjay.tanday@haymarket.com

INFORMING PATIENTS

  • Taking aspirin daily could prevent CHD in men aged 48 and over and in women aged 57 and over.
  • GPs already routinely prescribe aspirin for secondary prevention of CHD.
  • Aspirin should not be prescribed to patients who have a history of bleeding or stomach ulcers.

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