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Should Everyone Over 50 Take Aspirin?

Doctors Debate Risks and Benefits of Low-Dose Aspirin to Prevent Heart Attacks
WebMD Health News

June 16, 2005 -- Should everyone over 50 be taking low-dose aspirin to prevent heart attacks?

Some doctors think so. Some don't. The debate rages in the pages of the June 18 issue of the British Medical Journal.

"Each person, not a doctor, should evaluate the risks and benefits," argues Peter Elwood, MD, chairman of the Welsh Aspirin Group of Cardiff University in Penarth, Wales.

"A recommendation that aspirin be used ... in unselected people over a certain age could result in net harm," writes Colin Baigent, MD, of Oxford Radcliffe Infirmary in Oxford, England.

Balancing 2 Risks

Why should people over 50 consider taking daily low-dose aspirin? It's a no-brainer for people at high risk of a heart attack unless they are also at high risk of aspirin's side effects.

Aspirin reduces a person's risk of heart attack and stroke. And most people at risk of a heart attack don't know it. That's why Elwood and others suggest that it would be an overall benefit if everyone over 50 simply went ahead and took a baby aspirin every day.

"In our U.K. studies, over half of people over 50 are at risk, and aspirin would be beneficial," Elwood tells WebMD.

But people over 50 also are at risk of intestinal bleeding if they take aspirin every day.

"Aspirin roughly doubles the risk of gastrointestinal bleeding," Baigent notes.

Which risk is worse? That depends on how you look at it.

"It's a matter of how you value the benefits and harm," Elwood says. "The benefits of aspirin are reducing harm of heart attack and stroke. Both have devastating effects on a person and on that person's family. The risk from aspirin is a bleed that may lead to a stay in hospital, a blood transfusion. People need to determine which of those risks they value more and make their own decision."

Baigent points out that bleeds can also be fatal. He doesn't advise against using aspirin to prevent heart attacks. But he thinks the decision to do so should be based on a doctor's advice.

The U.S. Way

David Atkins, MD, MPH, is chief medical officer at the Center for Outcomes and Evidence, part of the U.S. Agency for Healthcare Research and Quality in Rockville, Md. Atkins helped write the U.S. guidelines for using aspirin to prevent heart attack and stroke.

Those 2002 guidelines say that doctors should discuss daily aspirin with any patient at risk of heart attack or stroke.

"The benefits of daily aspirin appear to be proportional to a person's underlying cardiac risk," Atkins tells WebMD. "My advice is it isn't something that should be taken without some additional thought. It is not so hard to assess a person's heart risk. So more and more guidelines say we should move beyond treating people at an age number and move toward treating the heart risk."

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