Low-dose aspirin should not routinely be used to prevent heart attacks and strokes, contrary to official guidance, say UK researchers.

Analysis of data from over 100,000 clinical trial participants found the risk of harm largely cancelled out the benefits of taking the drug.

Only those who have already had a heart attack or stroke should be advised to take a daily aspirin, they found.

The study should help clarify a "confusing" issue, a leading GP said.

The NHS drugs watchdog, the National Institute for health and Clinical Excellence (NICE), has not made a ruling in this area.

But experts in the UK, US and Europe recommend aspirin for people who have not already had a heart attack or stroke, but are at high risk of cardiovascular disease because of factors such as age, blood pressure and cholesterol level.

This strategy, known as primary prevention, is based on the result of studies looking at predicted risks and benefits in this population.

But the latest research is provides clearer evidence because it is based on data from individuals, the researchers said.

They looked at heart attacks and strokes and major bleeds - a potential side effect of aspirin - in six primary prevention trials, involving 95,000 people at low to average risk and 16 trials involving 17,000 people at high risk - because they had already had a heart attack or stroke.

Use of aspirin in the lower-risk group was found to reduce non-fatal heart attacks by around a fifth, with no difference in the risk of stroke or deaths from vascular causes.

But it also increased the risk of internal bleeding by around a third.

However, in those patients who had already had a heart attack or stroke and were at risk of having another, the benefits clearly outweighed the chance of adverse events, the researchers said.

Study leader Professor Colin Baigent from the Clinical Trial Service Unit at the University of Oxford, UK, said drug safety was vital when making recommendations that affected tens of millions of healthy people.

"We don't have good evidence that, for healthy people, the benefits of long-term aspirin exceed the risks by an appropriate margin."

He added: "I think the guideline groups will find it useful to have the data analysed in that way."

Professor Steve Field, chair of the Royal College of GPs, said the issue had been confusing for GPs and patients.

"There is no definitive guidance and it makes it bewildering when you have a series of papers which then hint it would be beneficial to take aspirin."

He added that many patients would buy aspirin over the counter - either on the advice of their GP or under their own steam - because it was cheap.

"This important study does suggest people shouldn't take aspirin unless indicated by disease."

Ellen Mason, senior cardiac nurse at the British Heart Foundation said: "It is better for doctors to weigh up the benefit and risk of prescribing aspirin on an individual basis, rather than develop a blanket guideline suggesting everyone at risk of heart disease is routinely given aspirin."

BBCNews

This topic has once more been in the news-

Quote:Aspirin does more harm than good in healthy people: research

Healthy people who take aspirin to prevent a heart attack are doing themselves more harm than good, researchers have said.

Millions of people - including a substantial number of the "worried well" - take a daily dose of the drug in the belief it will keep them healthy.

But at a conference for leading doctors, British scientists said they have found that for healthy people taking aspirin does not significantly reduce the risk of a heart attack.

At the same time they found it almost doubles the risk of being admitted to hospital due to internal bleeding.

The findings show that for otherwise healthy people the risks of taking aspirin outweigh the benefits. The doctors stressed that patients who had already suffered a heart attack should continue to take the drug.

It has been suggested that aspirin could be included in a so-called 'polypill' with an anti-cholesterol statin and a blood pressure drug which could be taken by everyone aged over 50.

Experts said substantial numbers of 'worried well' take aspirin as a 'just in case' measure believing that because it has been around for such a long time it is completely safe.

The results of a study carried out in Scotland and presented at the European Society of Cardiology Congress in Barcelona has added to the growing evidence that the risks outweigh the benefits for healthy people.

Prof Gerry Fowkes of the Wolfson Unit for Prevention of Peripheral Vascular Disease in Edinburgh, said: “Our research suggests that aspirin should not be prescribed to the general population at this stage.

“Aspirin probably leads to a minor reduction in future events but the problem is that has to be weighed against an increase in bleeding. Some of that bleeding can be quite serious and lead to death.”

Prof Peter Weissberg, Medical Director of the British Heart Foundation, which part-funded the study, said: "A lot of the worried well buy a small dose of aspirin over the counter not understanding that they are increasing their risk substantially of a major bleed."

He said it is known that aspirin does reduce the risk of cardiovascular problems but this must be countered against the increased risk of internal bleeding.

In patients who have already had a heart attack the risk of a second is so much higher that the balance is in favour of taking aspirin.

However, for people who have not had a heart attack the risks do not normally outweigh the benefits.

Prof Weissberg added: "If you have not got clear cut vascular disease that has caused an event while it does reduce the risk (of a heart attack or stroke) that benefit is offset by a worse risk of haemorrhage and potentially fatal haemorrhage."

In the study conducted in Scotland 29,000 men and women aged between 50 and 75 were screened to see if they had furred arteries in the legs, which means they are at high risk of developing heart disease but do not yet have symptoms.

More than 3,000 men were randomly assigned to receive a daily dose of aspirin or a dummy pill and were followed up for an average of eight years.

There was no difference in the rate of heart attacks or stroke between the two groups and deaths from any cause were similar.

However there were 34 major bleeds in people taking aspirin, or two per cent, compared with 20 or 1.2 per cent of those on the placebo.

He said the tablets were only taken 60 per cent of the time during the trial which reflects real life experience in people who have not had a heart attack.

He said in secondary prevention, where people have already had one attack and are trying to prevent a second one, compliance is usually better.

Earlier this year Oxford scientists found that although aspirin could cut the chances of a heart attack in patients who had never suffered one by a fifth, it also increased the risk of stomach bleeding by a third.

Nick Henderson Executive Director of the Aspirin Foundation said: "Aspirin use to prevent primary cardiovascular events is only appropriate where individual patients are considered by their doctor to be at special risk from particular factors such as obesity, lifestyle, stress and a familial history.

"The Aspirin Foundation continues to counsel individuals always to seek medical advice before embarking on a self medication prophylactic regime with Aspirin for whatever reason.

"Medical advocates of prophylactic Aspirin in the absence of previous cardiovascular events accept that potential benefits should be weighed against potential risks such as the bleeding demonstrated in the study by Professor Fowkes."

Telegraph.co.uk

Worrying for those of us who routinely do take a low dosage Aspirin on the doctor`s advice.

Daily aspirin could do more harm than good for some

CTV.ca News Staff

Date: Wednesday Nov. 4, 2009 1:26 PM ET

An aspirin a day might keep the doctor away if you already have a history of heart trouble, but it may not be a good idea if you're otherwise healthy, conclude British doctors.

Editors at the British Medical Journal's Drug and Therapeutics Bulletin, a journal that reviews medical treatments, say that people with no history of heart disease could be doing themselves more harm than good by taking a daily dose of aspirin.

Low-dose aspirin is widely prescribed to patients who have had heart attacks or strokes. It has been proven to block the formation of dangerous blood clots, which can cause secondary heart attacks or strokes.

But research has also suggested that aspirin has little impact on curbing death rates in those without a history of heart trouble. What's more, it can pose a significant risk for serious stomach or intestinal bleeding.

That risk appears to outweigh any benefits ASA, or acetylsalicylic acid, may offer, the DTB editors conclude.

"We believe that the currently available evidence does not justify the routine use of aspirin ... in apparently healthy individuals, including those with elevated blood pressure or diabetes," the review reads.

"This is because of the potential risk of serious bleeds and (the) lack of effect on mortality."

The editors say their analysis of six recent studies involving a total of 95,000 patients does not back up the routine use of aspirin in patients who had shown no sign of cardiovascular disease because of the bleeding risks and the negligible impact on curbing death rates.

DTB editor Dr. Ike Iheanacho said the risks appear to still outweigh the benefits even in patients thought to be at high risk of experiencing cardiovascular events, including those with diabetes or elevated blood pressure.

Iheanacho pointed to a study in the May 30 issue of the journal The Lancet. That study found that taking a daily low dose of ASA reduced the occurrence of heart attack, stroke and vascular death in test subjects by only 0.07 per cent compared to those who didn't take it. But daily aspirin also increased the patients' risk of serious gastrointestinal bleeding by 0.03 per cent per year compared to those who didn't take it.

The reviewers found that taking aspirin prevented three cardiovascular events for 1,000 women and four for every 1,000 men after an average of 6.4 years. At the same time, subjects suffered 2.5 major bleeding events for every 1,000 women and three major bleeding events for every 1,000 men.

The authors of The Lancet study concluded that the risks of taking ASA offset the benefits.

The U.S. Preventive Services Task Force looked at the aspirin issue this past March and concluded that aspirin could be recommended for men 45-79 and women 55-79 for primary prevention if the individual didn't have a high risk for GI bleeding.

In Canada, the Heart and Stroke Foundation takes a more cautious approach and recommends patients seek the advice of their doctors before beginning to take low-dose aspirin every day.

ctv.ca

The reason why aspirin is taken for heart disease is because it is an anti-inflammatory. Well guess what? There's a better solution that doesn't cause internal bleeding!!

Tula