Aspirin therapy revised

By Emma Ross

Associated Press

LONDON — Major new research shows that people at high risk of heart attack or stroke should be given one or two baby aspirins a day instead of regular strength adult aspirin.

The study also concluded that aspirin can help a wider range of people with potential heart trouble — those suffering from risky conditions such as diabetes, chest pain, irregular heart beat and diseased leg arteries — but who have not had a heart attack or stroke.

Aspirin has long been the cornerstone of blood-thinning treatment for people who have had a heart attack or stroke, but is not normally used for those who suffer potential precursor ailments.

The research found that aspirin reduced the risk of heart attack or stroke, or death from those events, by 25 percent even in patients who had not had a heart attack or stroke.

The findings come from an analysis that combines evidence accumulated over the years on the effectiveness of aspirin and its alternatives in staving off heart trouble. Coordinated by scientists at Oxford University in England, it encompassed 287 studies involving 200,000 people.

The most crucial advance offered by the study is in defining the appropriate dose of aspirin for long-term therapy, said Dr. Eric Topol, cardiology chief at the Cleveland Clinic, who was not involved in the analysis.

"That’s a big thing. Before this analysis, we weren’t sure what the dose was at all," Topol said. "325 milligrams was readily available, so it was used out of convenience, but now I think we’ve zeroed in on the range of 80 to 160."

Most doctors and heart specialists prescribe 325 milligrams of aspirin, the same as a regular strength adult aspirin tablet, per day when applying it as a blood thinner.

The latest analysis shows that between 75 milligrams and 150 milligrams works just as well, with less chance of internal bleeding. In the United States, a baby aspirin tablet, also available as low-dose adult aspirin, contains 81 milligrams.

"There are two problems," Topol concluded "Doctors are giving too much, or they are not giving any at all. We have a lot of work to do now to get all the patients treated and at the right dose.

"That dose should be considered to be one or two baby aspirin and not the standard 325 milligrams," he said.

A similar analysis performed in 1994 by the same group solidified the role of long-term daily aspirin treatment in avoiding second heart attacks or strokes in people who have already had one.

The latest review, published in the British Medical Journal, www.bmj.com, is a much-anticipated update.

"We’ve got clear evidence now from this review that people who haven’t yet had a heart attack or stroke do benefit, but they are being treated less than half the time with aspirin," said Dr. Colin Baigent, an epidemiologist at Oxford University and one of the investigators.

"If we were to tackle that group, that would save about 40,000 extra lives a year worldwide," he said.

The study concluded that most healthy people, who have less than a 1 percent chance of having a heart attack or stroke, should not regularly take aspirin to prevent heart trouble.

The key is to determine how unhealthy someone has to be to benefit from aspirin, Baigent said. If the likelihood of having a heart attack or stroke is smaller than the chance of internal bleeding from the aspirin, the drug would cause more harm than good.