AspirinEditor’s note: This is the eighth in a 10-part series detailing the top scientific research of 2014, as determined by the American Heart Association’s volunteer and staff leaders.
Aspirin is known to help reduce heart attacks in people who have already had one, but a large-scale study in Japan points out the lack of benefits and the risks of daily aspirin for people without heart disease.
Aspirin thins the blood to help prevent blood clots. It’s often used to prevent recurrent heart attacks and strokes, and it’s given to those who have stents to clear blocked arteries. The American Heart Association recommends that healthcare providers prescribe daily low-dose aspirin to heart attack survivors and consider prescribing it to people who are at high risk of heart attack and low risk of side effects.
But daily aspirin didn’t reduce the risk of heart attack, stroke or death for elderly Japanese people who were at risk, according to a study published in the Journal of the American Medical Association and presented at the American Heart Association’s Scientific Sessions 2014.
Researchers in Kyoto, Japan randomly assigned 100 mg a day of coated aspirin or no aspirin to 14,464 people, ages 60 to 85 with high blood pressure, high cholesterol or diabetes, but without coronary or cerebral artery disease. After five years, the two groups had no significant differences in heart attacks or strokes. Events were 2.77 percent for the aspirin-treated group compared to 2.96 percent in the no-aspirin group.
The results of the trial are among the top scientific cardiovascular developments in 2014, as determined by the American Heart Association.
“The available evidence does not support the routine use of aspirin in the primary prevention of cardiovascular events,” said Richard Becker, M.D., an AHA volunteer and director and physician-in-chief at the Heart, Lung and Vascular Institute at the University of Cincinnati College of Medicine in Ohio.
Despite a drop in heart attacks in the aspirin group, bleeding risks increased, including fatal and nonfatal bleeding strokes.
“Physicians should know this. In contrast, aspirin should be considered in all patients with knownatherosclerotic disease, particularly with prior events such as a heart attack or stroke, stent or bypass surgery,” Becker said. “The public and also many physicians have viewed aspirin as both safe and effective for primary prevention, despite an absence of resounding proof of benefit. It is associated with a clear risk for bleeding, including serious gastrointestinal and less commonly intracranial hemorrhage.”
Deepak L. Bhatt, M.D., M.P.H., an AHA volunteer and executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital Heart and Vascular Center in Boston, said the study results are consistent with previous studies.
“I think the decision to use aspirin for primary prevention in a patient needs to be individualized by the physician after a thoughtful discussion,” Bhatt said. “I would not routinely recommend aspirin for primary prevention unless future trials show a clear benefit.”