What’s the Evidence that Aspirin Prevents Heart Disease?
Taking low-dose aspirin remains one of the most common recommendations for preventing heart disease, like heart attack or stroke. But what is the actual evidence behind this recommendation? You might be surprised! . . .
A recent study of people with multiple risk factors for atherosclerosis, including high blood pressure, cholesterol problems or diabetes was cut short because, though aspirin did significantly increase the risk of side effects, it did not reduce the risk of cardiovascular events (JAMA 2014;312:2510-20).
And, though the FDA continues to endorse aspirin for people who have already had a heart attack or stroke, it recently refused to endorse it for prevention in people who have never had one. It found that there was evidence of “dangerous bleeding into the brain or stomach,” but no evidence of prevention of heart disease even for people at high risk due to family history.
A large and important meta-analysis of 754 studies compared non-steroidal anti-inflammatory drugs (NSAIDs) to either placebo or other NSAIDs and looked at their effect on major vascular events, like non-fatal heart attacks, non-fatal strokes or vascular death; major coronary events, like non-fatal heart attack or coronary death; stroke; mortality and heart failure. It found that ibuprofen increased the risk of major coronary events by a significant 222%. The NSAID diclofenac increased the risk of a major vascular event by a significant 41%, mostly due to a 70% increased risk of a major coronary event. Diclofenac increased the risk of death from vascular events by a significant 65%. Ibuprofen also increased the risk, but not significantly. All NSAIDs roughly doubled the chance of heart failure (Lancet 2013;382:769-79).
Recently, following a comprehensive review of the latest safety data, the FDA strengthened its label warnings that non-aspirin NSAIDs increase the risk of heart attack and stroke. The FDA says NSAIDs increase the risk of serious cardiovascular events, increase the risk of heart failure and increase the risk of dying in the first year after suffering a heart attack. They say that the risk increases with higher doses or longer use (FDA Safety Announcement 7-9- 2015).
Two recent reviews of all the existing data have also concluded that there is no clinical support for the use of low-dose aspirin for the prevention of heart attack or stroke. The first included nine studies that included over 100,000 people. It wanted to see if low-dose aspirin could help prevent heart attacks in people who had not had a prior heart attack. It found no benefit, but significant risk (Eur Heart J 2013;34:3403-3411). The second concluded that “There is no reliable evidence that aspirin used in the current fashionable doses of 50–100 mg/day is of any benefit in any common clinical setting” (Eur Heart J 2013;34:3412-8).
Though NSAIDs have no benefit for preventing heart disease in people without a history of prior heart attack, taking NSAIDs to prevent heart disease does have dangerous side effects, like bleeding into the brain or stomach. Aspirin is a serious cause of ulcers and gastrointestinal bleeding. A meta-analysis of 24 controlled studies revealed that even taking a low dose of aspirin does not reduce the risk of gastrointestinal bleeding (BMJ 2000;321:1183-7). 28% of people who take low dose aspirin to prevent heart disease develop an ulcer (Ailementary Pharmacology & Therapeutics 2005;22:795-801).
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