Instead of the old adage about an apple a day, many doctors advise their patients to take an aspirin a day to prevent heart attacks. Which may be good advice. But new research suggests that aspirin may not keep patients from dying of a heart attack.
Aspirin is thought to decrease the risk of death from a heart attack because it keeps blood clots from forming. This new study from Japan found no difference in the death rate between patients who took a daily dose of aspirin and those who did not.
Patients in the aspirin group had a 2.77 percent death rate. Those in the non-aspirin group had a 2.96 percent death rate – not a significant increase.
A research team led by Yasuo Ikeda, MD, of Waseda University in Tokyo, studied 14,464 patients from 1,007 clinics in Japan. The patients had high blood pressure, diabetes, or high cholesterol and triglyceride levels all risk factors for heart disease. The study included men and women aged 60 to 85.
Dr. Ikeda and team split the patients into two groups. One group received a daily dose of 100 milligrams of aspirin. The other group did not receive aspirin. The patients continued to take their regular medications.
The study authors followed the patients for five years. At the end of the five-year period, a review committee stopped the study because there was no evidence that aspirin was effective in reducing the death rate from heart attack or stroke.
The researchers found that an equal number of patients 56 died in each of the two groups.
Dr. Ikeda and team found that the aspirin group did, however, see a decreased risk of a nonfatal heart attack. Aspirin also reduced the risk of transient ischemic attacks, or TIAs. TIAs occur when the blood supply to the brain is temporarily reduced.
In the aspirin group, 114 patients had a stroke that did not cause death. In the non-aspirin group, that figure was 108. In the aspirin group, 20 patients had nonfatal heart attacks compared to 38 patients in the non-aspirin group.
Patients on aspirin were more likely to have bleeding that required hospitalization or blood transfusions. Patients who took a daily dose of aspirin were more likely to report stomach problems like stomach pain, heart burn or nausea.
The study was published Nov. 17 in JAMA and presented at the American Heart Associations Scientific Sessions 2014 in Chicago.
J. Michael Gaziano, MD, of Brigham and Womens Hospital and Harvard Medical School in Boston and an associate editor for JAMA, and Philip Greenland, MD, of the Northwestern University Feinberg School of Medicine in Chicago and a senior editor for JAMA, commented on the study in the Nov. 17 issue of JAMA.
Drs. Gaziano and Greenland said that, although the study did not provide evidence that aspirin reduced the death rate from heart disease, there are still times it should be used.
Patients who have a high short-term risk of a heart attack or stroke should receive aspirin, they said. Those who undergo certain medical procedures with a risk of heart attack or stroke should also receive aspirin.
Low-risk patients, however, should not take aspirin because of the risk of bleeding, the editorial authors wrote.
Drs. Gaziano and Greenland said that this study “adds to the body of evidence that helps refine the answer to the question of when aspirin should be used to prevent vascular events. Decision making involves an assessment of individual risk-to-benefit that should be discussed between clinician and patient.
Patients should not take daily aspirin (brand names Bayer, Ecotrin and Fasprin) unless advised by their doctors to do so.
The Japanese Ministry of Health, Labor, and Welfare and the Waksman Foundation of Japan funded the study. Bayer Yakuhin provided the aspirin used in the study free of charge. Dr. Ikeda and several other study authors received funds from medication manufacturers such as Bayer, which manufactures aspirin.