Wednesday, November 04, 2009


I would like to begin by saying that I am not on aspirin. I have never had sugns and symptoms of heart disease ( Touch wood ), and I am not on statins. Those are my conflict of interest statements.
I am writing to add my little voice to the UK Royal Colege of GPs call and also the call of the UK " Drug and Therpeutics Bulletin ( DTB )" for subjects ( they are not patients as they have no disease ) or patients without documented heart disease, to stop taking aspirin, in the hope of preventing heart attacks, and death.
Obviously, since the mid-eigthies, there have at various times been various clinical trials published which seemed to suggest that taking aspirin in subjects at risk of heart disease, would prevent heart attacks. In fact, since 2005-2008, there have been 4 guidelines published by respected professional bodies, which seem to suggest that aspirin is beneficial in primary prevention, and secondary prevention. Here, we need to define a few terms. Primary prevention is a strategy to prevent a disease condition in someone who does not yet have the disease condition. So primary prevention of heart disease is a strategy to prevent heart disease in sometime who has no heart disease. Secondary prevention, on the other hand, is a strategy to prevent further disease and complication, in someone who has the disease and have survive the disease. So secondary prevention of heart disease would be to prevention further heart attacks or death, in someone with heart disease ( survivors of heart attacks, patients who had angioplasties, or by-pass surgery, etc ).
Well, it would appear ( no doubt ) that aspirin, or antiplatelet agents ( aspirin, ticlid, clopidogrel, or other newer anti-platelets that are on their way ), are beneficial in patients with know heart disease to prevent another heart attack, or cardiac death.
However, the evidence of aspirin preventing cardiac death in primary prevention is rather very weak. The DTB reviewed clinical evidence from 6 large " RCT-Randomised clinical trials ) involving 95,000 subjects, and found that the use of aspirin in primary prevention is associated with an increase risk of GIT and cranial bleed without a benefit in lower cardiac death rates ( so all risk, no benefit ). There is a minor reduction in non-fatal heart attacks. This reviewed was published in the Lancet recently.
So for all those out there who are taking aspirin for primary prevention, please note that you have given yourself the risk of a GIT bleed and even worse, hemorrhagic stroke, without much cardiac benefit. I suggest that you consult your favourite GP for advice, and reconsider.

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