The controversy surrounding the use of aspirin for preventing cardiovascular disease in healthy patients is ongoing. A recent analysis of healthy patients without cardiovascular disease assessed the efficacy and safety of taking aspirin.
It is well-known that aspirin is beneficial in preventing strokes and heart attacks in patients with cardiovascular disease. About 80% of heart attacks and strokes are preventable. The ABCS of heart health guides healthcare practitioners to ensure Aspirin is taken appropriately, Blood pressure and Cholesterol are within normal targets, and patients have stopped Smoking.
Taking aspirin for preventing heart attacks and strokes in healthy patients has stirred considerable controversy in the healthcare professional community. Contrasting guideline recommendations are offered by many different associations including the European Guidelines on Cardiovascular Disease Prevention and the US Preventive Services Task Force.
What are the benefits and risks of aspirin for healthy patients?
Researchers from the Faculty of Medicine at the Imperial College and the Department of Cardiology at the King’s College Hospital in London, England conducted a review of studies assessing the efficacy and safety of taking aspirin. A total of 13 clinical trials including almost 165 000 patients were analyzed. The researchers evaluated the benefits and risks to healthy patients taking aspirin. Researchers were aiming to demonstrate the effectiveness of aspirin on cardiovascular mortality, non-fatal strokes, and non-fatal heart attacks. To assess the risks of taking aspirin, the English researchers searched for major bleeding events in each study.
The trials included in the analysis were all randomized clinical trials recruiting at least 1000 participants without a known history of cardiovascular disease. These studies compared aspirin at any dose with no treatment or placebo. The researchers only chose studies that included a follow-up of at least 12 months. The results of this study were published in the Journal of the American Medical Association.
Benefits include decreased heart-related deaths but risks include major bleeding events
In this review, taking aspirin was associated with a decrease in cardiovascular outcomes including cardiovascular mortality and nonfatal heart attacks and strokes. Unfortunately, taking aspirin was also associated with an increase in major bleeding events. The increase in the risk of major bleeds, including bleeding into the brain and gastrointestinal tract, and the decrease in the risk of cardiovascular events were of similar magnitude in this analysis. Compared with taking aspirin for preventing heart attacks and strokes in patients with known cardiovascular disease, the use of aspirin in healthy patients requires an individual assessment of the risks and benefits.
This study has several limitations. In a meta-analysis, the availability and quality of studies is a significant limitation. Several of the included studies were conducted over 20 years ago making their relevance questionable. The included trials did not all define cardiovascular outcomes and bleeding risks in the same manner. Lastly, the doses used in the trials ranged from 50mg to 500mg. Doses above 100mg are not representative of clinical practice.
Significant differences in recommendations for healthy patients
Taking aspirin has been shown to be beneficial for patients with known cardiovascular risks, but there is a significant difference in guideline recommendations for healthy patients. This study demonstrated that the decrease in cardiovascular risks is similar in magnitude to the increase in bleeding risk in healthy patients taking aspirin. Since low-dose aspirin is an easily accessible over-the-counter medicine, healthy patients should discuss the benefits and risks with their primary care provider before taking aspirin to prevent cardiovascular disease.
Written by Jessica Caporuscio, PharmD
- Zheng SL, Roddick AJ. Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis. JAMA. 2019.
- EurekAlert! Frequent use of aspirin can lead to increased bleeding. American Association for the Advancement of Science. 2019. https://www.eurekalert.org/pub_releases/2019-01/kcl-fuo012119.php
- Centers for Disease Control and Prevention. Preventing 1 Million Heart Attacks and Strokes. U.S. Department of Health & Human Services. Date Accessed: Jan 24 2019. https://www.cdc.gov/vitalsigns/million-hearts/index.html