Doctors: Don't forget about aspirin's benefits

Posted: Sunday, January 27, 2002

PHILADELPHIA -- A federal panel of doctors is urging people not to forget about aspirin's benefit for the heart, as high-profile drugs designed to lower cholesterol and treat pain continue to hit the market.

Some doctors are concerned that people who took an aspirin a day for high cholesterol or pain from ailments such as arthritis may have switched to new specialized drugs. They hope that a new set of guidelines will send the message that, for many people, an aspirin a day helps keep heart attacks away.

The guidelines, released by the U.S. Preventive Services Task Force and appearing in Tuesday's edition of Annals of Internal Medicine, are based on decades of research that indicates taking aspirin daily can prevent heart attacks.

''There isn't evidence that these new drugs prevent heart attacks so people shouldn't use those as a substitute for aspirin,'' said Dr. Cynthia Mulrow, a task force member and professor of medicine at the University of Texas Health Science Center at San Antonio.

Aspirin, which improves blood flow through the arteries by making it less sticky and less likely to clot, often is recommended to help prevent and treat heart problems.

Cholesterol-lowering statin drugs and pain-relieving cox-2 inhibitors, which millions of Americans take every day, don't appear to have that benefit.

The higher a person's heart attack risk, the more aspirin seems to help. The task force looked at 35 years of research on aspirin and heart health and defined high-risk people as anyone with high cholesterol levels or blood pressure, men over age 40, postmenopausal women, smokers and diabetics.

Data pooled from several studies showed that aspirin therapy reduced the risk for coronary heart disease by 28 percent, and the numbers get better for people with a moderate to high risk of heart disease.

''One of the things the task force wanted to get across is that the easiest and most cost-efficient intervention to lower one's risk of cardiovascular disease is low-dose aspirin,'' said Dr. Roger Blumenthal, director of preventive cardiology at Johns Hopkins University.

That doesn't mean that patients should stop their prescription medications in favor of aspirin. Many people can take a daily low-dose (about 75 mg) of aspirin in conjunction with their prescription pain or cholesterol medication, doctors said.

Mulrow, a co-author of the guidelines, said it's essential to first determine one's heart disease risk factor because aspirin's side effects -- including intestinal bleeding and hemorrhagic stroke -- can do more harm than good for people with healthy hearts.

To determine one's risk level, the report points to several Web site calculators, including one at www.med-decisions.com. Users can punch in statistics including blood pressure, cholesterol and age, and the site tells them what their chances are of having a heart attack in five years.

If your chance is 3 percent or greater, the task force says aspirin therapy is a good idea.

''It's a pretty straightforward message: Find out your risk and if your risk is elevated, see your physician and consider taking aspirin in low doses,'' Annals editor Dr. Harold Sox said.



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