A low dose of aspirin daily appears to be as effective as higher doses and safer at preventing heart attack and stroke, says U.S. health experts.
The debate surrounding who should take aspirin and what dose has been ongoing because aspirin carries an increased risk for gastrointestinal bleeding, the sudden loss of blood or perforation of the digestive tract that can lead to hospitalization or death.
The revised recommendations, by the U.S. Preventive Services Task Force, published in the March 17 issue of the Annals of Internal Medicine are designed to match age, gender, risk of gastrointestinal bleeding, diabetes and other health factors.
Among the new recommendations:
Men – 45 to 79 – should take aspirin if the chance of preventing heart attack outweighs the chance of gastrointestinal bleeding.
Women – 55 to 79 – should take aspirin if the chance of reducing a stroke outweighs the risk of gastrointestinal bleeding.
Women under 55 and men under 45 who have never had a stroke or heart attack should not take aspirin for prevention.
People taking clopidogrel (brand name Plavix), a clot-dissolving drug, should not take aspirin.
These recommendations do not apply to those people who have already had a heart attack or stroke.
The leading cause of death in the U.S. is heart disease. It is the underlying or contributing cause in nearly 58 percent of all deaths. In 2003, 1 in every 3 adults had some type of cardiovascular disease. In adults 40 and older, the risk is 2 in 3 for men and more than 1 in 2 for women.
The benefits of using aspirin have to be carefully balanced against the risks. If a patient has low risk of cardiac events in the near future, aspirin should not be prescribed. If the risk is high, clearly aspirin is needed, says Dr. Carl J. Lavie, at Ochsner Heart and Vascular Institute in New Orleans.
The last Task Force recommendations came out in 2002. At that time the panel acknowledged that the evidence for the use of aspirin in preventing heart problems was still revolving.
Another study in the same issue of the journal supports the new recommendations, finding that lower doses of aspirin taken daily ( 75 to 81 mg) are equally if not more effective than higher doses (100 mg or more) in preventing heart attack and stroke in at-risk individuals.
Aspirin is the most widely used drug to prevent heart attack and stroke worldwide. More than one-third of U.S. adults are believed to take aspirin each day, according to background information in the study.
The new recommendations are available on the AHRQ Web site. #