Aspirin does more harm than good in healthy people: research

Healthy people who take aspirin to prevent a heart attack are doing themselves more harm than good, researchers have said.

At the same time they found it almost doubles the risk of being admitted to hospital due to internal bleeding.

The findings show that for otherwise healthy people the risks of taking aspirin outweigh the benefits. The doctors stressed that patients who had already suffered a heart attack should continue to take the drug.

It has been suggested that aspirin could be included in a so-called 'polypill' with an anti-cholesterol statin and a blood pressure drug which could be taken by everyone aged over 50.

Experts said substantial numbers of 'worried well' take aspirin as a 'just in case' measure believing that because it has been around for such a long time it is completely safe.

The results of a study carried out in Scotland and presented at the European Society of Cardiology Congress in Barcelona has added to the growing evidence that the risks outweigh the benefits for healthy people.

Prof Gerry Fowkes of the Wolfson Unit for Prevention of Peripheral Vascular Disease in Edinburgh, said: “Our research suggests that aspirin should not be prescribed to the general population at this stage.

“Aspirin probably leads to a minor reduction in future events but the problem is that has to be weighed against an increase in bleeding. Some of that bleeding can be quite serious and lead to death.”

Prof Peter Weissberg, Medical Director of the British Heart Foundation, which part-funded the study, said: "A lot of the worried well buy a small dose of aspirin over the counter not understanding that they are increasing their risk substantially of a major bleed."

He said it is known that aspirin does reduce the risk of cardiovascular problems but this must be countered against the increased risk of internal bleeding.

In patients who have already had a heart attack the risk of a second is so much higher that the balance is in favour of taking aspirin.

However, for people who have not had a heart attack the risks do not normally outweigh the benefits.

Prof Weissberg added: "If you have not got clear cut vascular disease that has caused an event while it does reduce the risk (of a heart attack or stroke) that benefit is offset by a worse risk of haemorrhage and potentially fatal haemorrhage."

In the study conducted in Scotland 29,000 men and women aged between 50 and 75 were screened to see if they had furred arteries in the legs, which means they are at high risk of developing heart disease but do not yet have symptoms.

More than 3,000 men were randomly assigned to receive a daily dose of aspirin or a dummy pill and were followed up for an average of eight years.

There was no difference in the rate of heart attacks or stroke between the two groups and deaths from any cause were similar.

However there were 34 major bleeds in people taking aspirin, or two per cent, compared with 20 or 1.2 per cent of those on the placebo.

He said the tablets were only taken 60 per cent of the time during the trial which reflects real life experience in people who have not had a heart attack.

He said in secondary prevention, where people have already had one attack and are trying to prevent a second one, compliance is usually better.

Earlier this year Oxford scientists found that although aspirin could cut the chances of a heart attack in patients who had never suffered one by a fifth, it also increased the risk of stomach bleeding by a third.

Nick Henderson Executive Director of the Aspirin Foundation said: "Aspirin use to prevent primary cardiovascular events is only appropriate where individual patients are considered by their doctor to be at special risk from particular factors such as obesity, lifestyle, stress and a familial history.

"The Aspirin Foundation continues to counsel individuals always to seek medical advice before embarking on a self medication prophylactic regime with Aspirin for whatever reason.

"Medical advocates of prophylactic Aspirin in the absence of previous cardiovascular events accept that potential benefits should be weighed against potential risks such as the bleeding demonstrated in the study by Professor Fowkes."

 

Rebecca Smith

Daily Telegraph

Medical Editor in Barcelona
10:00PM BST 30 Aug 2009