Analysis of 287 trials involving more than 200,000 patients shows that giving aspirin to people with chronic conditions such as angina, peripheral artery disease and diabetes could save 40,000 lives a year, 12,000 of them in the United States, says a report in the Jan. 12 British Medical Journal.
Aspirin reduces the risk of heart attack and stroke by preventing the blood units called platelets from clumping together to form artery-blocking clots. It now is prescribed for some high-risk patients, notably those who have already had a heart attack, to prevent a second event, and it is credited with saving 100,000 lives a year worldwide.The new study, done over a number of years with funding by the British Heart Foundation and the Medical Research Council of Britain, says that the number of lives saved could be increased substantially because fewer than half the high-risk individuals who could benefit from aspirin are getting it.
The report also says that aspirin is as effective in reducing risk as prescription antiplatelet drugs, although some patients can benefit by taking another agent.
One reason why many patients aren't been prescribed aspirin is that "the evidence has not been convincing enough for physicians," says Dr. Colin Baigent, the Medical Research Council scientist who led the study. "A number of trials that have been conducted have been too small, so that doctors have not been convinced."
There is also fear about the danger of excessive bleeding caused by aspirin, Baigent says, but analysis shows that "the risk of bleeding is small compared to the benefits."
The new report could lead to a widening of the recommendations on aspirin use by the Food and Drug Administration, says Dr. Steven Weisman, who participated in the study when he was vice president for scientific affairs at the Aspirin Foundation. He now is head of the health care practice group at Innovative Science Solutions, a New Jersey health care consulting company.
In 1997, the FDA was asked to change the labeling so that aspirin would be recommended for patients with peripheral artery disease, which is narrowing of the arteries in the legs and arms that is associated with a high risk of heart attack and stroke. The agency said the evidence was not convincing enough to justify the change. That ruling and other limitations now are being reconsidered, Weisman says.
"There is great interest both on the industry side and the FDA side about making changes, so that aspirin would be recommended not only for people with established heart disease but also for men over 40 with high blood pressure and high cholesterol," he adds.
Underuse of aspirin is partly the fault of patients, Weisman says. "Because it is over-the-counter, people don't think of it having the efficacy that it does," he says. "People go home from the doctor's office with the prescription, but don't take it seriously. Also, people have been concerned about potential side effects and don't realize how effective it is. The benefits far outweigh the risk."
What To Do
Because there is some risk, self-prescription is not advisable, Weisman says. Taking aspirin regularly "should be done under the direction of a physician," he adds.
A history of aspirin as painkiller and artery saver, with current recommendations, is offered by the Food and Drug Administration. Meanwhile, try the American Heart Association to learn more about aspirin and your heart.