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Aspirin Can Prevent 1st Heart Attack

New study underscores drug's ability to protect the heart

WEDNESDAY, Sept. 24, 2003 (HealthDayNews) -- Doctors have long known of aspirin's ability to prevent second heart attacks and stroke.

Now, a new analysis of five large studies finds a significant reduction in first heart attacks among aspirin users.

"Aspirin reduces the risk of a first attack in healthy people by 32 percent," says study coauthor Patricia Hebert, an associate professor of cardiology at Yale University.

The researchers also found aspirin reduced the risk of all major cardiac events by 15 percent.

Hebert and her team collected data from the five studies of the 55,580 people, 11,466 of whom were women, according to her report in the latest issue of the Archives of Internal Medicine.

"When you consider whether or not a patient should be receiving aspirin to prevent a heart attack, you really need to think about their risk of having a heart attack," Hebert says.

Doctors need to look at your 10-year risk of having a first heart attack, and if that risk is 10 percent or higher, then you should be taking aspirin daily, Hebert notes. These are the recommendations of both the U.S. Preventive Services Task Force and the American Heart Association.

Hebert says your risk profile is based on a number of factors, including age, sex, weight, family history, diabetes, smoking and blood pressure and cholesterol levels.

"Aspirin to prevent a first heart attack is underused," Hebert says. People should talk with their doctors about what their risk for heart attack is to see if they should be taking aspirin daily, she advises.

The optimum daily dose of aspirin is about 75 milligrams, she adds.

"If more people took daily aspirin, it is estimated that 150,000 cardiovascular deaths could be prevented each year," Hebert says.

"If your risk of a first heart attack is 10 percent or more, than the chances are that the benefits of aspirin therapy will outweigh the risks," Hebert says. Risks of aspirin therapy can include gastrointestinal bleeding and a small risk of hemorrhagic stroke.

Patients with similar risk profiles for a heart attack might also want to take cholesterol-lowering drugs, called statins, Hebert says. "Most people who are eligible for aspirin therapy would also be eligible for statins," she notes.

The researchers add there isn't enough data to determine if aspirin also prevents ischemic stroke or vascular death.

Dr. David Katz, an associate clinical professor of public health at Yale University, notes that although there is nothing new in the study, it does give a good overview that reinforces what is already known.

He adds there are approaches to preventing heart disease that have no risks associated with them. These include eliminating risk factors, such as smoking, and being active and eating a healthy diet.

"These go a long way to preventing the cardiac risk factors that would cause you to have a 10 percent risk for a heart attack," he says.

"It comes down to a choice," Katz adds. "People who are willing to commit to the harder work of living a health-promoting lifestyle may never need aspirin to prevent heart disease. Those who can't make that commitment, or who have risk factors because of a genetic component or despite a healthful lifestyle, will find aspirin a very useful strategy for preventing heart disease, because it is very effective and not very toxic."

Katz agrees aspirin therapy is underused. "Both doctors and patients tend to be concerned about the potential toxicity of treatment. But what is ignored is the potential toxicity of non-treatment," he says.

While there are side effects to using aspirin, for those at risk for a heart attack, not taking aspirin carries a substantial risk of having a heart attack, Katz says.

"We don't need research on new drugs. We've got highly effective remedies now, and we're failing to use them," Katz stresses.

More information

For more information about heart disease, visit the National Heart, Lung, and Blood Institute. For more on aspirin therapy to prevent a heart attack or stroke, visit the American Heart Association.

SOURCES: Patricia Hebert, Ph.D., associate professor, cardiology, Yale University, New Haven, Conn; David Katz, M.D., M.P.H., associate clinical professor, public health, Yale University, New Haven, Conn.; Sept. 22, 2003, Archives of Internal Medicine
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