May 12, 2014
Preventing your first heart attack with a daily low-dose aspirin is a bad idea and could be putting you at risk for excessive bleeding, the Food and Drug Administration announced this week.
The agency reviewed a number of studies on the use of aspirin to prevent heart attacks and strokes among people who have never had either one before, and found that there was little evidence that suggests doing so is helpful. There wasn't enough of a benefit to taking a daily aspirin, the agency concluded, to outweigh the risks of potential bleeding problems in the stomach and the brain (bleeding in the brain can trigger stroke) caused by too much of the drug. Even people with diabetes or with peripheral vascular disease (a disease of the arteries and veins outside the heart and brain), both of which increase the risk of cardiovascular problems, didn't see a benefit from taking daily aspirin if they hadn't already had a stroke.
The agency is still recommending aspirin for people who've already suffered a heart attack or stroke, in which the risks of bleeding are outweighed by the scientifically demonstrated benefits of taking the drug.
The FDA's announcement was prompted by a request from Bayer, the maker of the most widely sold brand of aspirin on the market. Bayer wanted to be able to include recommendations that aspirin be used as primary prevention (in people who've never had heart attack or stroke) in the literature it gives to doctors. FDA denied that request after investigating the available evidence.
"In selected people at high risk for heart attacks, aspirin is of value to take," says Richard Stein, MD, spokesperson for the American Heart Association and a professor of medicine and cardiology at NYU School of Medicine. But, he adds, aspirin has been heavily marketed to consumers as a way to stave off heart problems. "Anyone can walk into a drugstore and see a bottle of Bayer's aspirin with a heart on it. But there's no evidence that giving it to low-risk people will lower the heart attack rate."
"The worry is that people are starting to put aspirin in the world of vitamins, that if you're worried about your heart, you should just take it every day," he adds. "I don't think that physicians are prescribing low-dose aspiring for low-risk people. With all the market advertising, most of the abuse among low-risk people is of their own decision."
And that's risky business, considering the way aspirin works. It prevents blood from clotting, and the benefit for heart patients is that it prevents blood from clotting and platelets from sticking to plaques forming on damaged artery walls. But problems arise when your body bleeds in other places, like the lining of your stomach wall or a vessel in your brain. "The same clotting isn't there to stop the bleeding, because the aspirin is interfering with that process," Dr. Klein says. The result is severe stomach bleeding or a potentially fatal hemorrhagic stroke.
"My thinking is that you should make regular [325-milligram] aspirin available over the counter, but the lower dose should be, ideally, prescribed by a doctor so that it's taken only under a doctor's recommendation or clearance," Dr. Klein says.