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.
March 30, 2005 - People at risk of developing strokes caused by narrowed arteries in the brain should consider aspirin instead of a common anti-clotting drug, new research suggests.
Aspirin worked just as well as warfarin in stroke patients with narrowed brain arteries, according to a study of 569 people at more than 50 sites across North America. But those on warfarin, which is marketed as Coumadin, suffered a higher death rate and more major bleeding compared to those who took aspirin.
Results appeared in the New England Journal of Medicine.
The study was done in patients who had suffered a stroke or mini-stroke as a result of a condition called symptomatic intracranial arterial stenosis. It is caused by the buildup of fatty deposits in the arteries’ inner walls, restricting blood flow. It’s unknown just how many people have the disorder, but it causes about 10 percent of the 900,000 strokes and mini-strokes that occur in the United States each year.
People with the condition currently take aspirin or warfarin to reduce stroke risk. Both work by thinning the blood, warding off clots that can block blood vessels.
Dr. Marc Chimowitz, a neurologist at Emory University and lead author of the study, said people with the disorder should not automatically stop taking warfarin or start an aspirin regimen without first consulting their doctors. He also noted that previous studies have shown the drug is useful in preventing strokes in people with other conditions like irregular heartbeat and clots in the legs and lungs.
In the latest study, patients randomly took either warfarin or high-dose aspirin. The aspirin group was given a daily dose of 1,300 milligrams, a higher amount than is recommended for heart disease and general stroke prevention. Researchers used the higher dose based on previous studies on its effectiveness. It was unclear whether another aspirin dose would lead to better results, Chimowitz said.
During follow-up, about one in five patients died from circulatory problems, had a second stroke or suffered brain hemorrhaging regardless of which drug they took. But the warfarin patients developed complications at a higher rate. Nearly 10 percent of them died compared to 4 percent who took aspirin. Those who took warfarin also had higher risks of major bleeding and suffering a heart attack or sudden death.
Dr. Jay Mohr, a neurologist who had no role in the study, said the results may force doctors to rethink the effectiveness of warfarin in stroke prevention.
"This will further influence doctors away from making a decision favoring warfarin as the strongest therapy," said Mohr of the Columbia University Medical Center in New York City.
The $15 million study, funded by the National Institutes of Health, was to last five years, but enrollment was halted midway after concerns were raised about the side effects associated with the group taking warfarin.
