Daily Mail 17th October 2008
Scientists say taking a daily aspirin to ward off heart attacks could do more harm than good
A daily aspirin taken to ward off heart attacks could do more harm than good, scientists warn today.
Routine use of the drug fails to prevent victims of type 2 diabetes suffering a first cardiac arrest, their research suggests.
They say there is no evidence to show it prevents a heart attack in the 'worried well' - healthy middle-aged people who take it as a precaution. I
n addition, it increases the risk of internal bleeding.
But they counselled against giving it up without a doctor's advice.
Aspirin is widely prescribed to diabetics, who are at much greater risk of heart disease.
This is based on its established role in reducing the risk of repeat heart attacks and stroke by up to a third.
However, a major study suggests that diabetics who have not had a previous heart attack gain no benefit from a daily dose.
Professor Jill Belch, of the Institute of Cardiovascular Research at Dundee University, said: 'If you're taking aspirin for secondary prevention because you've had a heart attack or stroke, or have a circulatory problem, then it works.
'But it doesn't work if you have none of these problems, and there is also no evidence for its use by healthy middle-aged people.'
She added, however: 'We do not want people taking aspirin prescribed by their doctor to stop taking it without seeking medical advice. They may have conditions for which it is suitable.'
Around 2.3million Britons have type 2 diabetes, which is closely linked with growing levels of obesity, and they are up to five times more at risk of heart disease than the general population.
A study led by Professor Belch, published today online in the British Medical Journal, involved 1,276 patients aged over 40 with diabetes and evidence of artery disease, who had not suffered a previous heart attack.
It found after eight years that there was no overall benefit from either aspirin or antioxidant treatment in preventing heart attacks or death. Patients in the aspirin groups had 116 heart attacks compared with 117 in those given placebos.
Professor Belch said there was widespread prescribing of aspirin in diabetes despite the lack of evidence to support its use. But studies show it can double the risk of stomach bleeding from an ulcer.
Aspirin is widely prescribed to diabetics, who are at much greater risk of heart disease
'Unfortunately aspirin has side effects and it's one of the biggest reasons for admission to hospital for drug-related adverse reactions, mainly gastrointestinal bleeding.
'Although the risk is relatively small, the numbers taking aspirin is large so it's a major problem.'
Professor Belch said there was international opposition to the study, mainly because U.S. guidelines recommend routine use of aspirin in patients with type 2 diabetes and millions are taking it.
'They were adamant that it was unethical to carry out this trial but I'm glad we persevered.'
She said clinical guidelines from various UK organisations recommending aspirin as primary prevention for diabetics should be changed.
There has also been growing pressure for 'blanket prescribing' of aspirin in middle age, with a report only last month from Nottingham and Sheffield researchers suggesting most healthy men over the age of 48 and women over 57 would benefit from the drug.
Research such as this has encouraged healthy middle-aged people to start taking aspirin bought over the counter without seeing a doctor - despite it not being recommended by any medical body.
Aspirin is also an ingredient of the ' Polypill', a single cheap multi-drug tablet being developed to slash the toll of heart attacks.
But this one-size-fits-all approach might now have to be rethought, said Professor Rory Collins, of Oxford University, a pioneer of large-scale studies into the causes and treatment of heart attacks.
His team is observing 10,000 diabetics who have been allocated daily aspirin or placebo, and has carried out a major analysis of existing studies.
The findings show any small benefit from using aspirin in those who have not had heart attacks is outweighed by the risk of stomach bleeding, he said.
'There has been a conflict between guidelines recommending the use of aspirin as primary prevention and the lack of evidence supporting this.
'But a lot of GPs are following these guidelines. When we were recruiting for our study, we found practices where all diabetic patients were being prescribed aspirin.
'The evidence is not there but the risk of bleeding is - and it goes up with age.'
No comments:
Post a Comment