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Aspirin Therapy for Heart Disease, Stroke Prevention Not for Everyone

Benefits and Risks of Aspirin Therapy Determined on Case-by-Case Basis
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Jan. 12, 2012 -- Many people who have never had a heart attack or stroke take an aspirin every day to lower their risk for these events.

While some may benefit, for many others the benefits appear to be outweighed by an increased risk for potentially serious and even life-threatening bleeding, a new study shows.

Researchers analyzed data from nine large studies, including three published since 2007, which followed participants for an average of six years.

Aspirin therapy was not associated with a reduction in deaths due to heart attack and stroke, but it was associated with a significant increase in risk for bleeding, says researcher Kausik K. Ray, MD.

“The benefits of aspirin therapy are clear for patients who have a history of heart attack or stroke,” Ray says. “This is not the case, however, for patients who may have risk factors for [heart disease and stroke] but have no such history.”

Aspirin: No Decrease in Heart, Cancer Deaths

The analysis included more than 100,000 people who had never had a heart attack or stroke and participated in trials in the United States, Europe, and Japan.

About half the participants took either low-dose (75-100 milligrams) or full-strength (300-500 milligrams) aspirin daily or every other day. Everyone else took placebos.

Over an average follow-up of six years, about 1,500 nonfatal and 500 fatal heart attacks and about 1,500 fatal and nonfatal strokes were recorded.

Aspirin therapy was associated with a 10% decrease in heart attacks and strokes, which was largely explained by a reduction in nonfatal heart attacks, Ray says.

But patients on the aspirin regimens were also 31% more likely to experience significant bleeding.

Aspirin therapy has been shown in several previous studies to be associated with a reduced risk of death from cancer, but the association was not seen in the new analysis, which was published in the Archives of Internal Medicine.

Ray and colleagues from the Cardiac and Vascular Sciences Research Center at St. George’s University of London conclude that for many patients with no history of heart attack or stroke, aspirin adds little to strategies proven to reduce heart disease and stroke risk.

These strategies include drug treatments that regulate blood pressure and cholesterol, and lifestyle changes such as smoking cessation, weight loss, and regular exercise.

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