More Evidence Not to Take Daily Aspirin If You’re Not at Risk for Heart Trouble or Stroke

About once a year, it seems, we caution readers about taking aspirin regularly to guard against heart problems, and now there’s more solid science to reinforce that advice.

A study published this month in the Journal of the American College of Cardiology showed that a significant number of cardiology patients are receiving aspirin primarily to prevent heart disease, despite the risk that the drug outweighs the potential benefit for many patients.

As interpreted by MedPage, too often aspirin is given to people for whom guidelines suggest no real benefit. The study examined a national registry of cardiology practices, and found that more than 11 in 100 uses of aspirin used preventively by cardiologists were for people outside the recommended risk threshold.

Although most people consider aspirin a gentle treatment for run-of-the-mill problems like headaches and fever, it also can help some people with heart trouble cases because it’s a blood thinner – it interferes with how blood clots by making platelets less “sticky.” The heart doesn’t work as hard to pump blood around the body when it’s thinner. But aspirin also makes people more susceptible to bleeding problems and gastrointestinal distress, including ulcers and colon problems. So unless you have a certain heart/stroke-risk profile, preventive use of aspirin is not wise.

Different cardiology practices reviewed in the study used aspirin preventively across a wide range; some cardiologists never used it for that purpose, but some used it for more than 7 in 10 patients.

“The variation across practices was so significant,” according to MedPage Today, “that a patient would be 63% more likely to get aspirin inappropriately at one randomly-selected office than an identical patient at another randomly-chosen practice.”

For patients with low cardiovascular disease risk who have never had symptoms of a heart problem, “aspirin use has not been associated with reduced cardiovascular events,” said the journal’s editor in an accompanying commentary. “In fact, in this primary prevention population, the increased risk of gastrointestinal bleeding and hemorrhagic stroke associated with aspirin use outweighs any potential benefit in cardiovascular risk reduction.”

MedPage Today referred to a five-year study of seniors in Japan who got a daily low-dose of aspirin, but it had no effect on their cardiovascular or stroke risk.

Last year, the FDA warned that its research review did not support the use of aspirin for primary prevention of heart attack and stroke, and as we blogged, the U.S. Preventive Services Task Force also recommended against its routine use. The American Heart Association and American College of Cardiology say aspirin is recommended only if someone’s risk for cardiovascular disease over a 10-year period is at least 6% to 10%.

That window excludes everyone who’s never had symptoms, family history, lifestyle habits or other demonstrated risks. In other words, don’t take aspirin regularly, even baby aspirin, if you’re healthy. If your doctor advises taking a daily aspirin for preventive purposes, ask why if you do not have an elevated risk for heart attack or stroke. If he or she does not have a clear, good reason – and “just in case” does not qualify – don’t take it.

The study involved more than 68,808 patients receiving aspirin for primary prevention at 119 different practices in the U.S. One positive finding was that the trend toward routine use of aspirin for prevention among low-risk patients declined over time, from 14.5 in 100 in 2008 to about 9 in 100 in 2013. But that’s still too many people taking a drug inappropriately.

Women were three times as likely to take aspirin when they shouldn’t – 16.6 in 100 women took it inappropriately, versus 5.3 in 100 men. And unnecessary risk-taking was more likely among the younger subjects (50 years old) than the older folks (66) in the study.

An editorial accompanying the study pointed out some shortcomings. Exclusively reviewing cardiology practice data might skew results because “the population seen by cardiologists usually differs from those in general practice,” it read.

And if patients take a statin in addition to aspirin, which is common, it could change a patient’s baseline risk profile. Statins, such as Lipitor or Zocor, lower cholesterol. But, according to MedPage Today, an analysis eliminating the statin users in the database showed similar findings – almost 15 in 100 people use aspirin inappropriately.

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