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Debate Grows on Aspirin for Heart Risk

Study Suggests Risks Outweigh Benefits of Taking Aspirin to Prevent Heart Attacks
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Aspirin Guidelines

Baigent believes health policy groups that now recommend aspirin for primary prevention should revisit their treatment policies.

In its own guidelines for the primary prevention of heart attack and stroke, the American Heart Association states that the benefits of low-dose aspirin (75 to 160 milligrams/day) outweigh the risks in most patients "at higher coronary risk."

But the guidelines also state that aspirin should not be given to patients who are aspirin intolerant or to those at risk for gastrointestinal bleeding and bleeding-related stroke.

American Heart Association spokesman and cardiologist Gerald Fletcher, MD, tells WebMD that he believes these guidelines are sound and that the benefits of low-dose aspirin do outweigh the risks in healthy people with a low risk of bleeding who are at risk for having a first heart attack.

He points out that in one of the studies included in the analysis, participants took 500 milligrams of aspirin daily.

"That's a lot of aspirin," he says, adding that lower doses are much safer.

But in an editorial published with the analysis, stroke researcher and neurologist Ale Algra, MD, wrote that risk factors should not be the only consideration when determining whether otherwise healthy people should take a daily aspirin.

In an interview with WebMD, Algra noted that while some patients may accept the risks, others might not want to take an aspirin every day if there is no clear benefit.

"The question today is not whether to give aspirin, it is whether to give aspirin in addition to these other medications," Baigent says. "Statins and blood pressure medications can reduce the risk of primary heart disease by about 50% and they are very safe."

Fletcher agrees that the main focus of patients and their clinicians should be on keeping cholesterol and blood pressure under control.

"People with high cholesterol need to get on a statin long before they think about aspirin," he says.

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