Aspirin is no longer for everyone

MONTREAL – Radical change in heart disease prevention: The American College of Cardiology and the American Heart Association are no longer recommending everyone to take aspirin on a daily basis, as it has been for decades.

“I have been in practice for twenty years and have always recommended aspirin,” said cardiologist Peter Guerra, who teaches at the Faculty of Medicine at the University of Montreal.

The change announced at the end of last week is a direct result of recent studies that have questioned the relevance of this approach. Aspirin has an effect on platelets, and large studies have found that the risk of bleeding seems to be greater than the prevention benefit against heart disease.

Two studies published last fall by the prestigious New England Journal of Medicine abounded in this regard. One found that aspirin did not prevent first strokes or first heart attacks in people at moderate risk. Another tested aspirin in people with diabetes, who are more likely to have heart problems or die, and found that the modest benefit noted was associated with an increased risk of serious bleeding.

So change is important, even if it is very specifically targeted at healthy people.

“We are questioning the use of aspirin in prevention, that is to say for patients who have never had a cardiac event,” said Dr. Guerra. It’s a distinction that’s pretty important. It is clear that patients who are cardiac and who take aspirin after a cardiac event (…) must continue to take their aspirin. ”

At one time, he continues, aspirin (the trade name for acetylsalicylic acid or ASA) was almost seen as a panacea, and was recommended to all people aged 50 and over.

However, studies and meta-analyzes conducted in recent years “suggest that the benefit of aspirin is not very good for patients in prevention,” said Dr. Guerra.

“Yes, it reduces the risk of a cardiovascular event a little, but not significantly,” he explained. The effect on prevention is minimal, especially for people who do not have risk factors. The benefit is marginal for people who are in perfect health. ”

However, the two American organizations warn that aspirin may have some place in prevention in patients whose risk of heart disease is very high, but that the issue will be discussed between the patient and his doctor.

The Canadian Cardiovascular Society had reservations about using aspirin for preventive purposes a few years ago. She can now be expected to reaffirm her position, Dr. Guerra believes.

In the meantime, healthy people who worry about their heart health would benefit from changing their diet, moving more and smoking less, instead of running to the local pharmacy to get aspirin.

“I do not recommend taking it,” said Dr. Guerra. When you give preventive treatment, you really have to be careful that there are no harmful side effects. To give aspirin in prevention, where the benefit is marginal at best, and where there is a risk (of bleeding), it becomes almost contradictory. “

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