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Aspirin – low doses - maybe not a good idea
Low-dose aspirin should not routinely be used to prevent heart attacks
and strokes, contrary to official guidance, say UK researchers.
Analysis of date from over 100,000 clinical trial participants found the
risk of harm largely cancelled out the benefits of taking the drug.
Only those who have already had a heart attack or stroke should be
advised to take a daily aspirin, they found.
The study should help clarify a "confusing" issue, a leading GP said.
The NHS drugs watchdog, the National Institute for health and Clinical
Excellence (NICE), has not made a ruling in this area.
But experts in the UK, US and Europe recommend aspirin for people who
have not already had a heart attack or stroke, but are at high risk of
cardiovascular disease because of factors such as age, blood pressure
and cholesterol level.
" We don't have good evidence that, for healthy people, the benefits of
long-term aspirin exceed the risks by an appropriate margin "
Professor Colin Baigent, study leader
This strategy, known as primary prevention, is based on the result of
studies looking at predicted risks and benefits in this population.
But the latest research is provides clearer evidence because it is based
on data from individuals, the researchers said.
They looked at heart attacks and strokes and major bleeds - a potential
side effect of aspirin - in six primary prevention trials, involving
95,000 people at low to average risk and 16 trials involving 17,000
people at high risk - because they had already had a heart attack or
stroke.
Use of aspirin in the lower-risk group was found to reduce non-fatal
heart attacks by around a fifth, with no difference in the risk of
stroke or deaths from vascular causes.
But it also increased the risk of internal bleeding by around a third.
Balance
However, in those patients who had already had a heart attack or stroke
and were at risk of having another, the benefits clearly outweighed the
chance of adverse events, the researchers said.
Study leader Professor Colin Baigent from the Clinical Trial Service
Unit at the University of Oxford, UK, said drug safety was vital when
making recommendations that affected tens of millions of healthy people.
"We don't have good evidence that, for healthy people, the benefits of
long-term aspirin exceed the risks by an appropriate margin."
He added: "I think the guideline groups will find it useful to have the
data analyzed in that way."
Professor Steve Field, chair of the Royal College of GPs, said the issue
had been confusing for GPs and patients.
"There is no definitive guidance and it makes it bewildering when you
have a series of papers which then hint it would be beneficial to take
aspirin."
He added that many patients would buy aspirin over the counter - either
on the advice of their GP or under their own steam - because it was
cheap.
"This important study does suggest people shouldn't take aspirin unless
indicated by disease."
Ellen Mason, senior cardiac nurse at the British Heart Foundation said:
"It is better for doctors to weigh up the benefit and risk of
prescribing aspirin on an individual basis, rather than develop a
blanket guideline suggesting everyone at risk of heart disease is
routinely given aspirin."
Story from BBC NEWS : news.bbc.co.uk/../8072215.stm
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