Aspirin Use in Primary Prevention – Meta Analysis
Aspirin has long been seen as a wonder drug with a low incidence of side effects and some significant positive effects on health. In particular the potential to reduce incidence of heart disease. SO much so tat Bayer and other manufacturer’s offer a low dose version of Aspirin that is targetted to the general public for heart disease prevention. But recent meta analysis of multiple data sets by Dr Colin Baigent from Oxford University suggests that the data does not support the general use of Aspirin in otherwise health individuals and catch all prevention for heart disease. The material was published in the Lancet (subscription required) and reviewed on Medscape (free membership required) – as Dr Baigent put it:
We have shown for the first time that the very same people at higher risk of heart disease are also at higher bleeding risk with aspirin, which is a very important piece of information and should influence the way in which aspirin is used.
So what to do given the latest evidence. There are many strategies and tools to use and no one size fits all. In fact based on the evidence in the meta analysis:
Medicine has moved on in recent years, and we now know that we can safely reduce risk of heart disease by lowering cholesterol and blood pressure, and the drugs used to lower these risk factors are probably safer than aspirin. A person wanting to lower their risk might well consider taking a statin or an antihypertensive first and only after that add in a less safe drug like aspirin.
The guidelines have not been changed and no doubt the guideline committees will review the latest data to determine if the guidelines need to be changed but int he meantime reviewin individual circumstances, family history and your own tolerance and experience with the various choices will influence decisions.
The major increased risk shown with Aspirin therapy was that of “major bleeds” which increased from 0.07 to 0.10% per year (absolute of 0.03% increase). These increases did not depend on other risk factors, age etc. And there appeared to be no “significant” trend in the positive effects of Aspirin in people at very low, low and moderate risk. There was an accompanying editorial from a clinical group out of Utrecht in the Netherlands that tried to provide some guidance on the relative risk and who should take Aspirin but the data and advice was disputed by Dr Baigent .
So review the choices, understand the risk and make your own choices based on consultation with your doctor and reviewing the updated findings and material