Issue 15, January 2010
3. Add on Aspirin: good or bad?

      On the basis of several guidelines it is a usual practice giving low-dose aspirin to prevent heart attacks and strokes in people who have not developed cardiovascular disease (CVD).

Revised ADA guidelines suggest that in moderate or low-risk patients, aspirin is of questionable benefit for primary prevention of cardiovascular disease. The revised recommendation is to consider aspirin treatment as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk, defined as a 10-year risk greater than 10%. Patients at increased cardiovascular risk include men older than 50 years or women older than 60 years with at least 1 additional major risk factor.

     Another review, published in the Drug and Therapeutics Bulletin says "The currently available evidence does not justify the routine use of low-dose aspirin for the primary prevention of CVD in apparently healthy individuals, including those with elevated blood pressure or diabetes due to the potential risks and lack of effect on mortality'.

     “Worldwide, many people take aspirin daily in the belief that doing so helps to prevent CVD. This approach is established for the secondary prevention of recurrent vascular events … there have been doubts about any benefits of aspirin in people with no history of CVD outweighing the risks”

     The randomized controlled trials that appeared recently in the Lancet showed that all-cause mortality and death resulting from coronary heart disease (CHD) and stroke did not differ between the aspirin group and the control group, those who received aspirin had an increased chance of severe gastrointestinal or extra-cranial bleeding.

Source : DTB 2009;47:122-125 oi:10.1136/dtb.2009.10.0045


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