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ASPIRIN TO PREVENT HEART ATTACKS

(April 2001)

Aspirin is advocated by some doctors and public health experts for apparently healthy people to prevent heart attacks or strokes. That recommendation is quite controversial. Aspirin is also recommended for those who have certain manifestations of coronary heart disease or evidence of mild strokes. There is general agreement on that use.

The major concern with aspirin treatment is the risk of bleeding, usually in the intestinal tract, sometimes in the brain. To reduce the dangers of long-term aspirin treatment, dosage is usually kept low - in the range of 50 to 160 milligrams a day (a full strength tablet is 500 milligrams).

An analysis of twenty-four studies published in the British Medical Journal November 11, 2000 concludes that the risk of intestinal bleeding with low dose aspirin is doubled and the risk of bleeding from low dose aspirin is the same as that from much higher doses.

The authors conclude "long term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal hemorrhage". No evidence exists that reducing the dose will reduce the incidence of gastrointestinal hemorrhage.

So, any dose of aspirin can cause internal bleeding that, on occasion, can be serious or even lethal. As noted in a Healthful Life newsletter (see Archives), it is unclear whether aspirin provides enough benefit in heart attack or stroke prevention in healthy people to recommend its use.

If the benefit is uncertain and the danger is small, but real, it obviously raises important questions because it means most people taking the aspirin are not going to benefit, but they still put themselves at risk of potentially dangerous bleeding.

Healthful Life does not recommend aspirin for prevention of heart attack or stroke in healthy adults, even for those who are at higher risk because of, for example, high blood cholesterol levels or high blood pressure, but have no symptoms.