Aspirin for the Heart May Be Unsafe for Low-Risk Individuals
I come across many people in the community who have self-prescribed aspirin to protect against heart attacks. Many of them are unaware that the evidence is still weak for primary prevention (preventing the initial attack) and that, even if you lower your risk for heart attack you increase your risk for stroke. Care to pick? Personally–I would rather lower my heart disease risk with twenty lifestyles changes that don’t increase my risk of stroke (and will probably actually decrease it!).
Heart 2001;85:265-271 Dr. L. E. Ramsay and colleagues, from the Royal Hallamshire Hospital in Sheffield, UK, performed a meta-analysis of four randomized controlled trials that assessed the beneficial and harmful effects of aspirin as a preventive measure for coronary heart disease. From this, the researchers were able to determine the usefulness of aspirin therapy based on a person’s risk of a coronary event. For people with a 1.5% or greater coronary event risk per year, aspirin is a safe and worthwhile means of primary prevention, Dr. Ramsay’s group determined. In people with a 1% risk, aspirin is safe, they found, but it is unlikely to be of much therapeutic value. However, in people with a 0.5% coronary event risk per year, aspirin therapy is actually unsafe, according to the report. In this group, the bleeding risks of aspirin are likely to outweigh any beneficial effects. “Aspirin cannot be prescribed safely for primary prevention of coronary heart disease without formal estimation of coronary disease event risk of the individual,” the researchers emphasize. “Accurate risk estimation requires counting and weighing of major risk factors for coronary heart disease, using risk functions derived from epidemiologic studies such as Framingham.”