Daily Aspirin: Do Risks Outweigh Benefits?

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Taking a daily low-dose aspirin can help prevent heart attacks or clot-related strokes in people with heart disease or a prior heart attack or stroke, but a recent report suggests that the risks of a daily aspirin regimen might outweigh the benefits in those without a history of these conditions.

The research, led by a panel of experts in the United Kingdom, looked at two large studies of people with diabetes and found that those who took 81–100 milligrams of aspirin daily were just as likely to have a heart attack or stroke within the next four to seven years as those who did not. And although aspirin can thin the blood and prevent blood clots, which cause roughly 80% of strokes, this medicine might increase the risk for hemorrhagic strokes (caused by bleeding in the brain) and gastrointestinal complications such as ulcers.

Roughly 50 million Americans, including some who do not have heart disease or a history of heart attack or stroke, take low-dose (325 milligrams daily or less) aspirin to prevent cardiovascular problems, an approach known as primary prevention. The American Diabetes Association (ADA) currently recommends a low-dose aspirin regimen for primary prevention in people with diabetes, who are at increased risk for cardiovascular disease.

However, this recommendation may soon be changing. According to M. Sue Kirkman, MD, Vice President of Clinical Affairs for the ADA, “Because of some recent studies suggesting that the benefit is not very large, and because aspirin can also have risks (intestinal bleeding or hemorrhagic stroke), the January 2010 [ADA Clinical Practice] Recommendations will recommend it mostly for higher-risk people than was the case in the past, when it was recommended for people with more moderate levels of risk and above.”

Nonetheless, Dr. Kirkman stresses that people who are taking aspirin should have a discussion with their doctor before making any changes to their aspirin therapy, noting that “There isn’t a strong rationale to take people off [aspirin] if they’re doing fine.”

To learn more, read the article “Risks of Daily Aspirin May Outweigh the Benefits” or see the study’s abstract in the Drug and Therapeutics Bulletin.

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