Should Everyone Over 50 Take Aspirin?
Doctors Debate Risks and Benefits of Low-Dose Aspirin to Prevent Heart Attacks
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,"
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
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