Aspirin Can't Replace Healthy Lifestyle

Aspirin for cardiovascular disease prevention was improperly prescribed in some patients

(RxWiki News) When it comes to heart health, many patients hope for a magic pill to prevent problems. Some thought that magic pill might be aspirin, but aspirin might not do the trick for everyone.

A recent study found that some patients at low risk for heart disease inappropriately received aspirin for heart disease prevention.

Such patients could benefit from alternatives that carry fewer risks than aspirin, the authors of this study said.

"Medical providers must consider whether the potential for bleeding outweighs the potential benefits of aspirin therapy in patients who don't yet meet the guidelines for prescribing aspirin therapy," said study authors Ravi S. Hira, MD, and Salim S. Virani, MD, PhD, of the Baylor College of Medicine in Houston, TX, in a press release. "Since aspirin is available over the counter, patient and public education against using aspirin without a medical provider's recommendation will also play a key role in avoiding inappropriate use."

Sarah Samaan, MD, a cardiologist at the Baylor Heart Hospital in Plano, TX, told dailyRx News that aspirin can help people at high or moderate risk for heart attack or stroke. Its benefits, however, should be balanced with the risk of bleeding, including ulcers and bleeding in the brain, she said.

"If you have cardiovascular disease already, then aspirin is likely an important preventive medication," Dr. Samaan said. "If not, your cardiologist or primary physician can calculate your individual risk for heart disease, which takes into account age, blood pressure, gender, cholesterol level, and whether or not you smoke. Other factors such as family history may also influence this decision."

Freek W.A. Verheugt, MD, of Radboud University Nijmegen Medical Centre in Amsterdam, wrote in an editorial that the study led by Dr. Hira may shed light on the risks of unnecessarily prescribing aspirin for heart disease prevention and help doctors find alternatives.

Extracranial bleeding, or bleeding outside the skull, is another potential risk of aspirin use, Dr. Verheugt wrote.

"Major coronary events (coronary heart disease mortality and nonfatal [myocardial infarction]) are reduced by 18 percent with aspirin but at the cost of an increase of 54 percent in major extracranial bleeding," Dr. Verheugt wrote. "For every two major coronary events shown to be prevented by ... aspirin, they occur at the cost of one major extracranial bleed. Primary prevention with aspirin is widely applied, however."

Myocardial infarction, also known as a heart attack, occurs when the heart muscle is damaged or dies due to inappropriate blood flow to it.

The current study looked at data on close to 70,000 patients who received aspirin to prevent heart disease. Almost 12 percent of those patients were prescribed aspirin inappropriately, Dr. Hira and team found.

Aspirin use was determined inappropriate in patients with a 10-year heart disease risk of less than 6 percent.

The American Heart Association (AHA) recommends low-dose aspirin use in people who suffered a heart attack or are at a high risk for one. Patients should not take aspirin without a doctor's prescription, according to the AHA.

"There is no pill or supplement that can take the place of a healthy way of life," Dr. Samaan said.

The study and editorial were published Jan. 12 in the Journal of the American College of Cardiology.

Study author Dr. Christie M. Ballantyne received grants from Abbott, Merck, Novartis, Pfizer and other pharmaceutical companies. Dr. Virani received grants from the Department of Veterans Affairs, the American Diabetes Association and the American Heart Association.

Review Date: 
January 12, 2015