Analysis Challenges Current Aspirin Recommendations for Heart Disease
Monday, February 26, 2024
International Study Sheds Light on Aspirin Use for Heart Health
In a groundbreaking analysis of data collected from three clinical trials, researchers have found evidence suggesting that the current guidelines for aspirin use in preventing heart disease may not apply to all patients. The findings, published in the prestigious medical journal Circulation, propose a personalized approach to aspirin use in the prevention of heart disease or stroke, a condition collectively known as cardiovascular disease.
Examining a Subset of Patients
The researchers conducted a comprehensive evaluation of data from over 47,000 patients across 10 different countries, including the United States, United Kingdom, and Australia. The focus of the analysis was on a subgroup of 7,222 patients who were already taking aspirin before the commencement of the three trials. These individuals were deemed to be at an increased risk for cardiovascular disease and were using aspirin as a preventive measure against heart attacks or strokes.
The Risk of Discontinuing Aspirin
What the data revealed was striking—a higher risk of heart disease or stroke, 12.5% versus 10.4%, among patients who had been taking aspirin prior to the trials but stopped it, compared to those who continued taking the drug. Moreover, the analysis did not find any significant statistical difference in the risk of major bleeding between the two groups of patients.
Shifting Perspectives on Aspirin Usage
Professor J. William McEvoy, a renowned expert in preventive cardiology, led the research in collaboration with experts from the University of Tasmania and Monash University, Melbourne.
Professor McEvoy emphasized the need to break away from a one-size-fits-all approach in aspirin use, stating, “We challenged the notion that aspirin discontinuation is a one-size-fits-all approach.”
The research team’s findings align with previous observational studies which indicated a 28% higher risk of heart disease or stroke in adults who, prescribed aspirin for risk reduction, decided to discontinue the drug against their doctors’ recommendations.
Based on major clinical trials conducted in 2018, the international guidelines no longer endorse the routine use of aspirin for the primary prevention of heart attacks or strokes. However, it should be noted that aspirin continues to be recommended for high-risk adults who have already experienced a heart disease or stroke event, as it helps to reduce the likelihood of recurrent incidents.
The Key: A Balanced Approach
The trials primarily evaluated the effects of initiating aspirin treatment in adults who had not previously taken the drug to reduce the risk of cardiovascular disease. Hence, the findings have limited implications for individuals who are already taking aspirin for primary prevention.
Professor McEvoy argues, “Our findings of the benefit of aspirin in reducing heart disease or stroke without an excess risk of bleeding in some patients could be due to the fact that adults already taking aspirin without a prior bleeding problem are inherently lower risk for a future bleeding problem from the medication. Therefore, they seem to get more of the benefits of aspirin with less of the risks.
These results may lay the foundation for future research, but as of now, they represent the best available data. Until further evidence emerges, it is reasonable to continue low-dose aspirin treatment for primary prevention in individuals without existing bleeding issues, unless new risk factors for aspirin-related bleeding emerge.”
The insights gained from this international study challenge current aspirin recommendations and urge a shift towards a more personalized evaluation of individual risk factors. While the research provides valuable insights, it opens the door for further studies that may refine our understanding of aspirin’s role in the prevention of heart disease.
Reference:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065420