Daily Low-Dose Aspirin Risks Seem to Outweigh Gains for Many: Study

TUESDAY, June 5 (HealthDay News) — Unless you’re at high risk
for cardiovascular disease, you probably shouldn’t take a low-dose aspirin
every day, a new study suggests.

Researchers report that daily low-dose aspirin use may significantly
increase the chance of major gastrointestinal or cerebral bleeding. Any
benefit of low-dose aspirin in preventing heart disease could be offset by
that risk, the study authors said.

“Aspirin is not effective in protecting a person from a first cardiac
event — a heart attack or stroke,” said study author Dr. Antonio
Nicolucci, head of the department of clinical pharmacology at nonprofit
biomedical research organization Consorzio Mario Negri Sud in Santa Maria
Imbaro, Italy. “In addition, taking aspirin has significant risks, and
thus shouldn’t be part of primary prevention unless you’re at moderate to
high risk of heart disease.”

Many heart attack survivors and others with multiple risk factors for
heart disease — such as high blood pressure, family history of heart
problems, obesity and diabetes — are advised to take low-dose aspirin.
For this study, low-dose aspirin was defined as 300 milligrams or
less.

The risk-benefit ratio should be carefully evaluated for each patient,
based on individual risk factors such as hypertension, elevated lipids,
obesity, diabetes and a family history of heart disease, Nicolucci
said.

While the study uncovered an association between daily aspirin use and
bleeding, it did not prove cause and effect.

Aspirin was associated with a 55 percent increased relative risk of
gastrointestinal bleeding, which translates to an additional two cases per
1,000 people treated, and a 54 percent increased relative risk of cerebral
bleeding.

The authors initially set out to discover the frequency of major
bleeding problems among people with and without diabetes. They also wanted
to learn how aspirin use affects bleeding in both groups.

The study, published June 6 in the Journal of the American Medical
Association
, highlights greater-than-expected risks for people without
diabetes who take low-dose aspirin in an effort to protect their heart
health, the researchers said.

The researchers also discovered that people with diabetes have a high
rate of major bleeding, whether or not they regularly take aspirin. They
found that aspirin therapy only marginally increases the risk of bleeding
in diabetics, possibly because it is less effective in suppressing
clotting ability in this group.

The study included more than 186,000 people aged 30 or older being
treated with low-dose aspirin and more than 186,000 who were not. During
six years, more than 6,900 first episodes of major bleeding requiring
hospitalization were documented, including nearly 4,500 episodes of
gastrointestinal bleeding and nearly 2,500 episodes of brain
hemorrhage.

Study data also showed a substantially lower risk of both
gastrointestinal and intracranial bleeding associated with the use of
cholesterol-lowering medications known as statins. The data, based on more
than 2,000 episodes of cerebral bleeding, suggests statins protect against
such hemorrhage.

One expert stressed that aspirin is a strong medication.

“Although it’s commonly found in the household medicine cabinet,
aspirin is not a simple drug,” said Dr. Christopher Cannon, a cardiologist
at Brigham and Women’s Hospital in Boston and a professor of medicine at
Harvard Medical School. “It’s a powerful medication that can produce side
effects — notably bleeding. We can’t just put aspirin in the drinking
water. People will bleed.”

If you already take aspirin on a daily basis and have concerns, consult
your doctor before making any changes.

Several key lifestyle factors were not considered in the data
collection and evaluation, including obesity, smoking, high alcohol
consumption or the use of over-the-counter nonsteroidal anti-inflammatory
drugs (NSAIDs). And because the study participants were from a select
group, the authors said the results might not generalize to an entire
population.

More information

To learn more about preventing heart disease, see the U.S. National Library of Medicine.

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