Benefits of Aspirin Outweigh Risks

The benefits of aspirin in reducing the risk of a second heart attack or stroke outweigh the risks of bleeding in the gastrointestinal tract, said researchers in a report in the current issue of the Archives of Internal Medicine.

The authors, David Y. Graham, M.D., chief of gastroenterology at the Veterans Affairs Medical Center and professor of medicine in Baylor College of Medicine’s gastroenterology section, and Steve Weisman, Ph.D., of Innovative Science Solutions LLC, found that concern over the risks and benefits of aspirin may have persuaded many patients not to take aspirin or make their physicians leery of prescribing it. Yet, aspirin has clear benefit in reducing risk of cardiovascular disease in those who are at highest risk of repeat occurrences.

The study was funded by Bayer Corporation, Consumer Care Division in Morristown, N.J.

“A lot of people who are candidates for aspirin don’t take it or aren’t prescribed it because of fear about the effects on the gastrointestinal tract,” said Weisman. “There is significant underutilization of aspirin as a secondary preventive.”

In a meta-analysis of six different studies involving more than 6,000 patients and designed to test aspirin’s effectiveness in reducing the risk of second heart attack and stroke, the scientists determined that 1.5 deaths could be prevented for every nonfatal bleeding incident in the gastrointestinal tract that was attributed to the use of aspirin. The studies involved patients who had already had heart attacks or strokes.

“There were approximately 18 percent fewer deaths, 20 percent fewer strokes and 30 percent fewer myocardial infarctions (heart attacks) in the people who took aspirin,” said Graham. The doses ranged from 50 milligrams to 325 milligrams per day.

“There were 558 new myocardial infarcts, 424 strokes and 91 other vascular events, along with 532 deaths and 58 reports of nonfatal gastrointestinal bleeding,” said Graham. Of the patients reporting gastrointestinal bleeding, 41 were taking aspirin and 17 were not.

It is clear that providing aspirin in this high-risk group has definite benefits, he said, and that the benefits outweigh the risks. Long-term acid reducing medications can reduce the risk of gastrointestinal bleeding, as can medications prescribed for the treatment of Helicobacter pylori, the bacteria associated with ulcers.

The American Heart Association recommends aspirin for those who have experienced a myocardial infarction (heart attack), unstable angina (chest pain) and stroke caused by narrowing of the arteries or blood clots that obstruct the arteries, if not contraindicated.

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©2006 Texas Medical Center

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