First Heart Attacks: Avoidable with Aspirin

You have probably heard that aspirin prevents heart attacks in people with heart disease . But did you know that it also works in healthy people without pre-existing cardiovascular problems? Research has shown that aspirin is effective in preventing first heart attacks in healthy people who have risk factors for the disease. It does this by staving off blood clots that can trigger heart attacks. But does this mean everyone should be taking aspirin therapy? According to the studies, the answer to that question is no, unless you have risk factors for the disease. US Preventive Services Task ForceThe US Preventive Services Task Force (USPSTF) published guidelines on aspirin for the primary prevention of cardiovascular events in the Archives of Internal Medicine . USPSTF is an independent panel of medical experts sponsored by the US Public Health Service. In its latest installment, the task force analyzed five randomized trials in which aspirin was used to prevent first heart attacks in healthy people. The combined studies followed more than 50,000 participantsprimarily middle aged and older people, among whom one-fifth were womenover periods of four to seven years.Pooled data from all the studies showed that adults at increased risk for coronary heart disease who take aspirin have an average risk reduction of 28% compared to control groups. The most favorable results occur in adults with a 5-year risk of heart disease greater than 3%, or a 10-year risk greater than 6%. The research also confirms that aspirin increases the risk of bleeding complications of the digestive tract and brain.
USPSTF concludes that aspirin is probably beneficial for patients who have no previous diagnosis of coronary heart disease but are at high risk for developing it. Patients at low risk (for heart disease) probably do not benefit from and may even be harmed by aspirin because the risk for adverse events may exceed the benefits, notes USPSTF. American Heart AssociationThe American Heart Association (AHA) also has recommendations that reflect advances in cardiovascular disease prevention that have occurred since its original guidelines were published in 1997. AHAs guidelines agree with USPSTF in the use of aspirin in persons at high coronary risk, but recommend it when the 10-year risk of heart disease exceeds 10% (compared to 6% for USPSTF). Calculating Your RiskMen older than 40 years, postmenopausal women, and younger people with risk factors for coronary heart disease are at increased risk for heart disease and may wish to consider aspirin therapy, says USPSTF. The main risk factors to consider are: age, sex, diabetes , elevated total cholesterol , low levels of HDL (good) cholesterol, high blood pressure , smoking, and a family history of heart disease.You can calculate your risk of heart disease using calculators that are designed for this purpose on the Internet. Access them free of charge at:
http://www.med-decisions.com http://www.americanheart.org/heartprofilers http://hin.nhlbi.nih.gov/atpiii/calculator.asp http://www.intmed.mcw.edu/clincalc/heartrisk.html Consulting Your DoctorIf you think aspirin therapy may be right for you, be sure to discuss the pros and cons with your doctor. Both AHA and USPSTF advise a medical consult every five years during middle age or older, or when new or additional cardiovascular risk factors are detected. The discussion should take into account your calculated risk for heart disease, the known protective effects of aspirin, potential side effects (such as bleeding of the digestive tract or brain), factors that increase your risk of side effects, and your personal preferences about medical care.According to the AHA and USPSTF guidelines, factors to keep in mind during decision making include:Aspirin doses of about 75 milligrams (mgs) a day appear to be as effective as higher doses. This is the amount in one-quarter of a regular strength aspirin. Research indicates that side effects increase with higher doses of aspirin.Enteric coated or buffered products do not clearly reduce the adverse gastrointestinal effects of aspirin.The risk of bleeding side effects from aspirin is increased in people with uncontrolled hypertension and those taking nonsteroidal anti-inflammatory agents or anticoagulants (blood-thinners). Some seniorsdepending on their age and health conditionmay also have a higher risk of adverse effects.In a re-review of all aspirin primary prevention trials, published in the Archives of Internal Medicine , there was a 32% reduction in the risk of a first heart attack (slightly better than the previous review), confirming previous research and substantiating recommendations from the USPSTF and AHA.

For apparently healthy individuals whose 10-year risk of a first coronary event is 10% or greater, the benefits of long-term aspirin therapy are likely to outweigh any risks, the researchers conclude. Based on the latest evidence, maybe its time to ask your doctor about aspirin therapy.

RESOURCES:

American Academy of Family Physicians

http://familydoctor.org

American Heart Association

http://www.americanheart.org

National Heart, Lung, and Blood Institute

http://www.nhlbi.nih.gov

The heart.org

http://www.theheart.org

References

Boltri JM, Akerson MR, Vogel RL. Aspirin prophylaxis in patients at low risk for cardiovascular disease: a systematic review of all-cause mortality. J Fam Pract. 2002;51:700-704.

Eidelman RS, Hebert PR, Weisman SM, Hennekens CH. An update on aspirin in the primary prevention of cardiovascular disease. Arch of Intern Med. 2003;163:2006-2010.

Hennekens CH. Update on aspirin in the treatment and prevention of cardiovascular disease. Family Practice Recertification. 2002; 24:3-12.

Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation. 2002;106:388-391.

US Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendations and rationale. Ann of Intern Med. 2002;136:157-160.

Last reviewed January 2006 by Steven Bratman, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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