Is Aspirin Really a Wonder Drug for Cardiovascular Prevention?

VA Researcher Questions Daily Use of Drug in Many Patients

By Brenda L. Mooney

Anthony Bavry, MD

GAINESVILLE, FL—Since the mid-1980s, aspirin has been used as a preventive drug for cardiovascular disease. In fact, the U.S. Preventive Services Task Force (USPSTF) says that about 40% of American adults over 50 currently take a daily aspirin to prevent heart attacks or strokes.

Some percentage of those patients might be putting themselves at unnecessary risk without much benefit, however, suggested a new study led by a VA researcher.

Anthony Bavry, MD, a cardiologist at the North Florida/South Georgia Veterans Health System, and colleagues found that aspirin appears to provide little or no benefit for certain patients who have plaque buildup in their arteries.

While aspirin reduces blood clots, the researchers reviewed the health histories of more than 33,000 patients with atherosclerosis to find that acetylsalicylic acid is only marginally beneficial for those who have had a previous heart attack, stroke or other blood-flow issues involving arteries.

For atherosclerosis patients without prior heart attack or stroke, the common drug showed no benefit, according to the article in Clinical Cardiology.1

The research was observational, but Bavry, who also is a professor at the University of Florida School of Medicine, suggested that the results call into question the extremely widespread use of aspirin for cardiovascular prevention.

“Aspirin therapy is widely used and embraced by cardiologists and general practitioners around the world,” Bavry pointed out. “This takes a bit of the luster off the use of aspirin.”

“The cardiology community needs to appreciate that aspirin deserves ongoing study,” he added. “There are many individuals who may not be deriving a benefit from aspirin. If we can identify those patients and spare them from aspirin, we’re doing a good thing.”

Bavry emphasized that the drug remains essential in emergency situations such as an ongoing heart attack or stroke, when patients should immediately take aspirin.

Enrolled in the nationwide study, which used data from late 2003 to mid-2009, were patients at least 45 years old with coronary artery disease, cerebrovascular disease or peripheral vascular disease.

In the prior ischemic event group, the risk of the first occurrence of cardiovascular death, myocardial infarction (MI), or stroke at a median of 41 months was marginally lower with aspirin users vs. nonusers—15.2% vs 15.8%; hazard ratio [HR]: 0.81.

For those atherosclerosis patients who had not experienced a heart attack or stroke, aspirin appeared to have no effect. The risk of cardiovascular death, heart attack and stroke was 10.7% aspirin users and 10.5% for non-users, for an HR of 1.03.

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