June 29, 2000 -- Ever since news broke that a simple over-the-counter tablet might help reduce heart disease, millions of Americans have been popping aspirin along with their morning vitamins in the hope of preventing a heart attack or stroke.
Now, British researchers have found that not everyone should be taking aspirin. In fact, for some, it can be harmful. Their study appears in the July issue of the British Medical Journal.
"Aspirin is an amazing drug that has a vital and conclusive part to play in reducing the risk of heart attack or stroke," says Belinda Linden, medical spokeswoman for the British Heart Foundation (BHF), which helped fund the study. "In this study, people who already had high blood pressure did not have any particular benefit," she tells WebMD. "In fact, they may have increased risk of bleeding." Linden is cardiac nurse adviser and head of medical information with the BHF in London.
This particular study looked at the protective factor of taking a daily, low-dose (75 mg) aspirin tablet in more than 5,000 men aged 45 to 69 who were at increased risk of heart disease. Researchers found that for this group without verified heart disease, overall risk of heart attack and stroke was cut by 20% after taking low-dose aspirin. But men with higher blood pressures were found to derive no protective benefit, Linden says.
"These study results give us an opportunity to say to people that chronic heart disease is internationally one of the biggest killer diseases, and there are many things that we all can do to reduce our own risk," says Paul Fawcett, spokesman for the BHF. "If people are thinking about that, that's a good thing. But if they're thinking that all they have to do is take an aspirin, then maybe they need to think again." Lifestyle, he tells WebMD, " has a very big impact."
The American Heart Association (AHA) recently developed recommendations for using aspirin in the primary prevention of heart disease. Among them:
- An intensive program should be started to modify risk factors that include smoking, high blood pressure, high cholesterol, physical inactivity, obesity, and diabetes.
- The decision to take aspirin should be made only after consulting with your physician.
- Anyone starting a regular aspirin regime should be aware that the medication does have side effects.
Side effects can include ulcers -- particularly in the stomach and in the first part of the small intestine. Aspirin also can cause you to bleed more easily. The bleeding can be in the stomach or intestines, or happen in the brain, causing a stroke. Also, skin wounds don't stop bleeding as easily.
Valentin Fuster, MD, past president of the AHA, tells WebMD that the new study confirms what the organization found earlier. If any modification needs to be made to the AHA guidelines, he says, it is "be cautious when giving aspirin" if one of the patient's risk factors is high blood pressure, "because it may make things worse." Fuster is director of the cardiovascular institute at Mount Sinai Medical Center in New York City.
However, the study may expand the use of aspirin by one cardiologist. "We give aspirin to everyone with coronary disease, regardless of blood pressure," says Steven L. Almany, MD, FACC, medical director of cardiology at William Beaumont Hospital in Royal Oak, Mich. "I don't usually put people on aspirin unless they're over 55 or have [heart disease]. That won't change," he says. "Now, if someone younger -- under age 50, says they want to take aspirin, I might say yes. Before, I would have said no." Almany was not involved in the study.
Linden says studies have been designed to look at heart disease in women, and further research is planned. Still, she says, "anybody who has evidence of coronary heart disease or stroke should be taking aspirin, unless they have a bleeding problem or their doctor has advised against it.
"Aspirin is a fantastic drug to cut the risk of heart disease," Linden adds. "However, if people do not have evidence of heart disease or a family history of it, this research does not suggest they take aspirin to help them." Because many people have high blood pressure and don't know it, she stresses the importance of being carefully monitored by your physician.
"There are ways to protect yourself against coronary heart disease if you haven't got it," Linden says. "But for many people, particularly those with heart disease, aspirin is not the only answer."
"Existing heart patients should continue to take aspirin as prescribed by their doctors," Fawcett says. "For them, the benefits are well-established."
For more information from WebMD, visit our Diseases and Conditions Heart Disease page.