Low-dose aspirin has become a low-cost, over-the-counter preventative regimen to avoid cardiovascular events. It acts as a blood thinner, reducing the risk of clots forming that can cause strokes and heart attacks. Doctors have known that aspirin works against second- and third-time incidents. But two new studies both show that a daily dose of aspirin increases the risk of bleeding while yielding mixed results as to whether it helps to prevent a first-time heart attack or stroke.
The ASCEND study in the United Kingdom involved 15,480 participants with diabetes who are not known to have any heart or vascular disease. This study looked at whether taking 100 mg of aspirin and fish oil supplements would safely reduce serious vascular events in these patients.
“They actually did find a reduction in the endpoint of cardiovascular events,” said cardiologist Andrew Kates, M.D. of Barnes-Jewish Hospital. “Patients did benefit from being treated with aspirin. The cost for it, though, was a higher risk for bleeding.”
As reported in the New England Journal of Medicine, “Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard.”
“So, there’s a tradeoff, avoiding a heart attack or stroke – but with a higher bleeding risk,” Dr. Kates said.
The finding on the omega 3 fatty acid fish oil supplement showed no benefit.
Findings of the ARRIVE study were presented late last month at the European Society of Cardiology’s 2018 Congress held in Munich, Germany. It involved 12,546 participants who were men age 55 and older and women age 60 and older without cardiovascular disease and no diabetes or high risk for bleeding. Dr. Kates, a professor of Medicine at and director of the Cardiology Fellowship program at Washington University School of Medicine, attended the conference.
“They gave the patients 100 mg of aspirin daily and looking at the effect on outcomes – heart attack, strokes, cardiovascular death and other things – and there was no benefit from being treated with aspirin versus placebo,” Dr. Kates said, “but there was an increase in bleeding,” specifically gastrointestinal bleeding.
If you are currently taking a daily low-dose aspirin, he said, do not stop taking them until you first speak to your doctor.
For patients who already have experienced a stroke or heart attack, that low dose or baby aspirin does serve as secondary prevention for another occurrence.
“For patients who do have cardiovascular disease, or you’ve had a heart attack or stroke, or you’ve got a stent put in or if you have peripheral vascular disease – those are patients who should really continue on aspirin,” Dr. Kates said. “The data is very good to show that that does reduce the risk of cardiovascular events.”
