The latest issue of the Drug and Therapeutics Bulletin (DTB) reports that the use of low-dose aspirin to protect against heart attacks and strokes in individuals yet to develop obvious cardiovascular disease, should be abandoned. Low-dose aspirin is widely used to prevent further episodes of cardiovascular disease in people who have already had problems such as a heart attack or stroke. This approach is known as secondary prevention. It is well established and of confirmed benefit.
Following an analysis of the available evidence, it is the use of aspirin in primary prevention with which DTB takes issue. This is for individuals without symptoms, who have not yet had, for example, a heart attack or stroke, but who may be at risk.
Across the European Union alone, cardiovascular disease accounted for two million deaths in 2000. “Worldwide, many people take aspirin every day in the belief that doing so helps prevent [cardiovascular disease],” says DTB.
DTB points to various guidelines issued between 2005 and 2008 that recommend aspirin for the primary prevention of cardiovascular disease in various groups of patients. Examples include people aged 50 and older with type 2 diabetes and those with high blood pressure.
However DTB indicates that current evidence does not support the routine use of low-dose aspirin in such groups. This is because of the potential risk of serious gastrointestinal bleeds that accompany its use and the slight impact it has on curbing death rates.
DTB recommends that doctors review all patients currently taking low-dose aspirin for primary prevention, either as prescribed or over-the-counter treatment. It adds that the decision about whether to maintain or discontinue treatment should be made only after fully informing patients of the available evidence.
DTB adds: “Furthermore, in our view, current evidence makes it hard to recommend starting aspirin for primary prevention.”
DTB concludes: “… current evidence for primary prevention suggests the benefits and harms of aspirin in this setting may be more finely balanced than previously thought, even in individuals estimated to be at high risk of experiencing cardiovascular events, including those with diabetes or elevated blood pressure.”
“We believe, therefore, that low dose aspirin prophylaxis should not be routinely used for primary prevention.”
“Aspirin for primary prevention of cardiovascular disease? ”
DTB vol 47; No 11, November 2009.
dtb.bmj.com Written by Stephanie Brunner (B.A.)