Aspirin and Antiplatelet Medications (cont.)

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How effective is aspirin for preventing heart attacks among healthy people?

Long-term, low dose aspirin (75-160 mg/d) infrequently causes serious side effects; therefore, among people with advanced atherosclerosis (people who already have heart attacks and strokes, patients with angina or TIAs, and patients who need PTCA and coronary artery bypass surgery. The benefits of low dose aspirin usually outweigh the risks of long-term aspirin (discussed in this article).

Unlike the treatment of patients with advanced atherosclerosis, aspirin use among healthy subjects (for example, individuals with no prior heart attacks or strokes) is more controversial. In the U.S. Physicians' Health Study (a study comparing 325 mg of aspirin every other day to placebo among more than 20,000 healthy male doctors), there were fewer heart attacks among aspirin users as compared to placebo users. However, the overall rate of death from heart disease was no different between aspirin users and men on placebo. Furthermore, there is insufficient data to evaluate the benefit of aspirin among healthy women.

Therefore, the potential benefits of long-term aspirin in healthy subjects may not justify the risks of serious side effects of aspirin, including bleeding from ulcers and blood vessels in the brain. Healthy individuals should discuss long-term therapy with aspirin with their doctors before they start taking aspirin.

What are the latest recommendations on the use of aspirin in the primary prevention of cardiovascular disease?

In 2009, the U.S. Preventive Services Task Force (USPSTF) has come up with slightly modified recommendations for the primary prevention of cardiovascular disease using aspirin. Based on their review of the published data:

  • They encourage the use of aspirin in men between 45-79 years of age and women between 55-79.
  • In individuals older than 80, the treatment with aspirin was associated with more bleeding episodes which outweigh the protective benefits.
  • In men younger than 45 and women younger than 55, the benefits of aspirin seemed to too insignificant to warrant routine use for the prevention of cardiovascular disease.

In 2014 the FDA reviewed all the evidence on the use of aspirin for primary prevention and did not find sufficient evidence for use of aspirin for primary prevention.

Medically Reviewed by a Doctor on 10/15/2015

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