Behind the Headlines: Does aspirin help prevent MI?

Taking a daily aspirin to prevent MI could do more harm than good, say media reports.

UK researchers found that regular aspirin use did not cut the risk of MI and strokes in high-risk patients with diabetes and peripheral arterial disease (PAD), but increased the risk of GI bleeding.

The findings contradict guidance from the Scottish Intercollegiate Guidelines Network and the Joint British Societies, which recommends aspirin for primary prevention of MI and strokes. The study found no evidence that antioxidants could lower the risk of cardiovascular disease (CVD).

Aspirin is still useful post-MI

What is the research?
The trial involved 1,276 adults, aged 40 and over, who had diabetes and an ankle brachial pressure index of 0.99 or less.

Patients with existing heart disease, PAD symptoms, already on aspirin or an antioxidant, or with a history of severe indigestion and ulcers were excluded.

Participants were randomly assigned to take either 100mg of aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant or double placebo, and monitored for eight years.

In the aspirin groups, 116 fatal and non-fatal MIs and strokes occurred compared with 117 in the no aspirin groups. Aspirin did not cut PAD risk, with 18.3 per cent in the aspirin group and 18.2 per cent in the placebo group undergoing ankle amputation.

What do the researchers say?
The researchers, led by Professor Jill Belch from the Institute of Cardiovascular Research at the University of Dundee, are concerned at the widespread prescribing of aspirin despite little evidence to support its use and its possible side-effects.

The study found 'no evidence to support the use of either aspirin or antioxidants in the primary prevention of cardiovascular events and mortality in people with diabetes'.

But they said aspirin should still be prescribed for secondary prevention of CVD.

What do other researchers say?
Caroline Butler, care adviser at Diabetes UK, said: 'Diabetes UK would certainly not recommend patients stop taking aspirin without consulting their GP or healthcare professional.

'Diabetes UK currently recommends aspirin treatment for adults with diabetes over the age of 50 and some younger people depending on their risk factors. However, this is under review.'

sanjay.tanday@haymarket.com

BMJ Online 2008

Informing Patients

  • Taking aspirin daily is not effective for primary prevention against MI and strokes and could increase the risk of GI bleeding.
  • Aspirin should continue to be given to patients who have suffered an MI.

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