Sponsored by
Daily pill that could be doing more harm than good
HEALTHY people should not take aspirin to prevent heart attacks because the risks could outweigh the potential benefits, health researchers have warned. A review of studies on use of the drug has concluded that people who do not have obvious cardiovascular disease should abandon their daily tablet.
After carrying out the review, an editorial in The Drugs and Therapeutics Bulletin (DTB) recommends that doctors should reassess all patients taking the drug for prevention of heart disease. The review, covering six separate sets of controlled trials reported that taking aspirin does not prevent cardiovascular disease deaths in people without symptoms of cardiovascular disease (CVD) and can cause serious internal bleeding.
Low-dose aspirin is widely used by people who have already had a heart attack or stroke to help prevent further episodes. This "secondary prevention" approach is known to have real benefit and has become a well-established strategy.
But, since the benefit of aspirin in secondary prevention became established a few years ago, many thousands of people who have no history or symptoms of heart attack or stroke are thought to have taken to popping a small dose of the drug each day as a preventative measure, but without being prescribed it.
Over the last few years, the DTB says various different sets of health guidelines have been issued which recommended aspirin for "primary prevention" of cardiovascular disease in patients showing no symptoms. They included people aged 50-plus with type 2 diabetes and those with high blood pressure.
A study of trials involving 95,000 patients carried out earlier this year warned that taking aspirin where there was no history of heart attack or stroke could do more harm than good. The benefits are much more finely balanced against harm than was previously thought, even in individuals estimated to be at high risk of experiencing cardiovascular events, including those with diabetes or high blood pressure.
In the latest advice, the DTB stresses that patients who already have cardiovascular problems should continue to take aspirin if they have already been prescribed the medication. But the journal calls on doctors to review giving the drug to others, such as diabetics and those with high blood pressure.
"What we know about aspirin is that it makes the blood less sticky," says David Phizackerley of the DTB. "For those with cardiovascular disease it prevents further cardiac events, working by making the blood less sticky, preventing the blood vessels from narrowing further."
The prescribed dosage of aspirin given to patients who have cardiovascular disease and may have already had a stroke or heart attack is 75-100mg a day – a small amount compared to that routinely taken to deal with pain. Trials carried out in 2002 suggested that a low dosage might be of benefit for people who had not suffered a stroke or heart attack.
"But that trial was based on a mixed group of those who had and those who hadn't had a cardiovascular event of some kind," says Mr Phizackerley. "Now we have data showing that for those who haven't had a stroke or heart attack, the benefits are small. Looking at information on those who have taken aspirin but have no symptoms or disease, in other words people who are well, taking aspirin didn't prevent deaths.
"The chance of reducing heart attack, weighed against chances of suffering internal bleeding were almost the same."
Research shows that in people taking aspirin for 6.4 years, it would prevent three cardiovascular events per 1,000 women, and four per 1,000 in men.
But it would cause two and a half women per thousand and three men per 1,000 to suffer serious gastrointestinal bleeding.
The bleeding, if severe, shows in stools and can lead to anaemia or acute illness and the need for blood transfusion. It's caused because a side-effect of aspirin is that it irritates and damages production of the gastric mucosa, or protective layer inside the stomach.
Professor Steve Field, chairman of the Royal College of General Practitioners, called the DTB "an excellent source of independent advice for medical professionals..." and "...Given the evidence, the DTB's statement on aspirin prescription is a sensible one. The Royal College of General Practitioners would support their call for existing guidelines on aspirin prescription to be amended and for a review of patients currently taking aspirin for prevention."
No-one should be taking aspirin unless it is prescribed by a doctor, says Cathy Ross, a senior cardiac nurse at the British Heart Foundation.
"There was some thought a few years ago that it might be beneficial for people over 50 to take the drug, but unless you already have heart disease or circulatory disease the risk of taking aspirin outweighs
the benefit. Anyone already prescribed it should continue, though.
"We advise people not to take aspirin daily unless it's prescribed by their doctor."
Ms Ross added that anyone over 40 should, in any event, go to their general practitioner and ask for a cardiovascular risk assessment, which includes checks on blood pressure, cholesterol and blood tests.
The results are analysed and the patient is then told what the risk is over the next 10 years of them developing cardiovascular disease.
A result of 20 per cent-plus is high and the patient might be started on drugs to deal with any particular blood pressure /cholesterol /other problems, as well as being recommended lifestyle changes to tackle any weight, smoking, exercise and other issues that could be contributing to the high risk.
" Patients whose risk factor is lower are are given advice on healthy lifestyle choices and monitored regularly.
"Most people in the 20 per cent-plus group either take no exercise, smoke, are diabetic or have family history of cardiovascular disease. One noticeable factor, though, is that if a patient doesn't exercise they'll often tell you that their parents didn't either.
"The same goes for diet – if parents eat a diet high in saturated fat, it's unlikely that their children will eat as healthily as they should.
"The best way to reduce your risk of developing cardiovascular disease is to avoid smoking, eat a diet low in saturated fat and rich in fruit and vegetables, and take regular physical activity."
Aspirin - a wonder drug
n The effects of aspirin-like substances have been known since the ancient Greeks recorded the use of the willow bark as a fever fighter.
n The leaves and bark of the willow tree contain a substance called salicin, a naturally occurring compound similar to acetylsalicylic acid, the chemical name for aspirin.
n Aspirin's discovery was actually the result of the work of several scientists. In 1897 Felix Hoffman, a chemist with the German pharmaceutical firm Friedrich Bayer and Company was searching
for a treatment for his father's arthritis pain. He experimented with salicin and created salicylic acid (SA), the first stable form of a product later named Aspirin.
n The product name is "a" from acetyl, "spir" from the spirea plant (which yields salicin) and "in", a common suffix for medications. By 1899 the Bayer Company was providing aspirin in powder form to physicians to give to patients.
n Aspirin soon became the number one drug worldwide, and in 1915 aspirin became available without prescription. It went on to be available in easy-to-swallow tablets with special coating, and in weaker dosages and chewable form for children.
n Not only is aspirin a painkiller; it is also a potential lifesaver due to its use in helping to prevent further strokes or heart attacks in those who have already suffered such events.
Email to a friend
Print this page- Leeds lose Ward to Palace: Is there anyone they can afford now?
- Sheffield Wednesday leaving it late to hijack Leeds United over Ward
- As Snodgrass dithers over Leeds, Warnock throws a lifeline
- Ball is in Leeds United’s court over contract - Snodgrass
- Police turning blind eye to Asian voter fraud, says MP
Looking for...
Featured advertisers
Jobs
Search for a job
Motors
Search for a car
Property
Search for a house
Weather for Yorkshire
Saturday 26 May 2012
Today
Sunny
Temperature: 8 C to 21 C
Wind Speed: 17 mph
Wind direction: East
Tomorrow
Sunny
Temperature: 9 C to 22 C
Wind Speed: 13 mph
Wind direction: East
