In the May 30th edition of The Lancet, there’s a new study which definitely increases the debate about whether it is worth the risk of internal bleeding to give daily aspirin to otherwise healthy people. Aspirin is of huge benefit to those who have already had an event such as a heart attack or a stroke due to ischemia (a “non-bleeding” stroke), but of course aspirin carries with it an increased risk of bleeding, either gastrointestinal or strokes caused by bleeding.
The Lancet study analyzed results from six primary prevention trials (individuals who had not had a stroke or heart attack so far) and from 16 secondary prevention trials (individuals who had had previous vascular events such as heart attack).
In the primary prevention trials, aspirin reduced heart attacks by about a fifth, but the net effect on stroke was not significant. Aspirin increased major gastrointestinal and extracranial bleeds to 0.10% from 0.07% per year, a significant increase. In the secondary prevention trials, aspirin reduced non-bleeding stroke and heart attacks, both by about a fifth.
Currently aspirin is used widely for prevention in people with moderately raised risk of coronary heart disease, including a lot of people who are considered to have a raised risk simply due to their age. An alternative to starting daily aspirin with healthy people would be to delay the start of daily aspirin until there is evidence of vascular disease, but of course it is always possible for the very first such signal to be a fatal heart attack or disabling stroke. This study points out that statins, a class of cholesterol-lowering drugs, are widely available and inexpensive (in generic form) and could be used as a prevention instead of aspirin with a lower risk.
Obviously if your doctor has advised you to take aspirin daily because you have turned 50 or are on the pill or any other reason, do not just stop it without talking to him/her. But if you have not had a heart attack or stroke, this study would be a good thing to discuss. My own doctor is a huge fan of low-dose aspirin therapy, to the point that he says he and his wife have a lot of small bruises! With any therapy, the risks always have to be weighed against the benefits (or risks of doing nothing), so do talk to your doctor if you have concerns about aspirin therapy for prevention of heart attacks or strokes.