The whole truth about aspirin and heart attacks: here's why it doesn't work

According to new analyzes, it is uncertain whether aspirin should be recommended for cardiovascular prevention in diabetic patients without existing cardiovascular disease.

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Taking a low-dose aspirin every day has long been known to reduce the chances of another heart attack, stroke, or other heart problems in people who have already had one. Now new studies show that, on the other hand, there is no need to "prevent" with acetylsalicylic acid in people who are predisposed.

According to the results of new research published in the New England Journal of Medicine, aspirin prevented serious vascular events in patients with diabetes who did not already have cardiovascular disease, but it caused almost as many major bleeding and there was no effect on tumors.

Patients with diabetes are, on average, at an increased risk of cardiovascular disease. Aspirin reduces the risk of secondary cardiovascular events and is recommended for patients with evidence of cardiovascular disease. However, its role in preventing early events (primary prevention) is less clear due to increased bleeding. It is therefore uncertain whether aspirin should be recommended for cardiovascular prevention in diabetic patients without existing cardiovascular disease.

So far and for many years, many studies have indicated that a substantial reduction in the risk of acute cardio-vascular events could be achieved in both type 1 and type 2 diabetes patients with systematic aspirin. And this was true both before and after a first episode of myocardial infarction or stroke. Furthermore, many analyzes of primary prevention (in subjects initially free from cardiovascular disease), and secondary prevention (already suffering from cardiovascular disease) demonstrate the effectiveness of chronic treatment with acetylsalicylic acid and indicate the effectiveness of preventive treatment. long-term with low doses of acetylsalicylic acid, especially in diabetic subjects with high cardiovascular risk.

Now, Professor Jane Armitage, a researcher at the University of Oxford, UK, said: “While we have clearly shown that aspirin reduces the risk of vascular events, including heart attacks, strokes and mini-strokes, it has also increased the risk of major bleeding, mainly from the gastrointestinal tract, so overall there is no clear benefit. It had been suggested that low-dose aspirin might protect against cancer, but we have not seen any reduction in any cancer; we are continuing to follow the participants to see if any benefits appear later ”.

The A Study of Cardiovascular Events iN Diabetes (ASCEND) study examined whether aspirin reduced the risk of a first cardiovascular event in patients with diabetes. Between 2005 and 2011, 15.480 patients with diabetes without any cardiovascular disease were randomly treated with aspirin (100 mg per day) and corresponding placebo.

Over the years, serious health effects that occurred during the follow-up of the participants were recorded, including in particular:

- a first serious vascular event, which included non-fatal heart attacks, non-fatal strokes or transient ischemic attacks (sometimes called "mini-strokes"), or death from cardiovascular causes (but excluding any intracranial haemorrhage, i.e. bleeding in the head or brain);

- first major bleeding, which included bleeding in the head or brain, intestines or other parts of the body that was severe enough to be fatal.

During an average of 7,4 years of follow-up, a first serious vascular event occurred in 685 (8,5%) participants taking aspirin and 743 (9,6%) assigned to placebo. A first major bleeding occurred in 314 (4,1%) participants assigned to aspirin and 245 (3,2%) participants in the placebo group, meaning that 9 out of 1.000 participants experienced major bleeding during the trial. cause of aspirin.

As a result, overall, the number of participants who avoided a severe vascular event was outweighed by those who experienced a major bleeding. Even among trial participants at the highest vascular risk (over 2% per year), a similar number of serious vascular events such as major bleeding caused were avoided. It was not possible to identify a group of patients in the study in which the benefits clearly outweighed the risks.

Previous studies had suggested that aspirin might produce a reduction in tumors in the intestine, with the effects increasing over time. A large number of tumors were observed during the follow-up in the ASCEND study and yet no effect of aspirin on gastrointestinal carcinoma was observednor was there any apparent effect of aspirin on overall cancer risk.

Armitage explains: “We have shown that aspirin reduces the risk of vascular events in primary prevention, such as in people who already have cardiovascular disease, but these benefits are offset by the number of major bleeds caused by aspirin. This is an important finding with implications for many millions of people who have diabetes but have not yet had cardiovascular events ”.

Read also

  • Cardioaspirin: all side effects and contraindications
  • Aspirin: Reduces the risk of colon cancer, but only if you have a gene

Germana Carillo

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