June 20, 2005 - In a recent issue of British Medical Journal, two experts give two different opinions on whether everyone over age 50 should take a daily aspirin to reduce their risk of heart attack and stroke.
Currently, daily aspirin is given to people whose five-year risk of a heart attack or stroke is 3 percent or more. This translates to about 80 percent of men and 50 percent of women over 50. There is also evidence surfacing that regular aspirin may reduce risk of cancer and dementia.
As proponents of daily aspirin, Peter Elmwood and colleagues at Cardiff University in the United Kingdom believe evidence supports more widespread use of aspirin. They say there needs to be a strategy to inform the public and enable people to make their own decision.
They write, "The possibility that a simple, daily, inexpensive low-dose pill would achieve a reduction in vascular events and might achieve reductions in cancer and dementia without the need for screening, deserves serious consideration."
However, Colin Baigent of the Oxford Radcliff Infirmary, says it would be unwise to adopt a blanket policy, no matter what age threshold is chosen, until a net benefit is shown for taking regular aspirin.
He says based on data for 55- to 59-year-olds, aspirin prevents around two heart attacks per 1,000 people. However, this benefit does not outweigh the expected risk of gastrointestinal bleeding, which is one to two people per 1,000.
Baigent says, "A recommendation that aspirin be used for primary prevention of vascular disease in unselected people over a certain age could result in net harm, and we must have very good evidence to the contrary before instituting such a policy." He calls for more trials on regular aspirin use.
NEW YORK - Dec 22 2004 - Aspirin use has increased among diabetics in recent years in the US, but new research indicates that certain high-risk individuals, particularly women and adults younger than 50 years, are underusing this effective and inexpensive agent.
The findings, which appeared in the Archives of Internal Medicine for December 13/27 2004, are based on telephone surveys conducted in several states between 1997 and 2001. Data from more than 8000 diabetics were included in the analysis.
Aspirin use rose from 37.5% in 1997 to 48.7% in 2001, Dr. Stephen D. Persell and Dr. David W. Baker, from Northwestern University in Chicago, note.
In 2001, the use of aspirin among diabetics was high in the presence of cardiovascular disease -- 74.2%, but low in its absence -- 37.9%. Moreover, less than 40% of diabetics with hypertension, high cholesterol or current smoking used aspirin.
Compared with men 65 years or older, women 35 to 49 years were 65% less likely to use aspirin. The corresponding rates for women 50 to 64 years, and men 35 to 49 years were 31% and 38%, respectively. This disparity was attenuated, but still apparent when the analysis was confined to patients diagnosed with cardiovascular disease.
The authors believe that clinicians may play a key role in increasing aspirin usage in the groups identified. They add that "interventions that aim to increase professional counseling about aspirin for women, as well as young and middle-aged adults, may be especially helpful."
Arch Intern Med 2004;164:2492-2499.