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12/23/2009 - News

Use of Aspirin in Heart Attack Prevention Called into Question

By: June Chen, MD


Many studies have shown the benefits of aspirin in individuals with vascular disease who are at risk for heart attack and stroke. But, what about the benefits of aspirin in primary prevention?

In the May 30, 2009 issue of The Lancet, researchers report that the value of aspirin in reducing heart attack and stroke among people without previous evidence of vascular disease is uncertain.


Investigators from the Antithrombotic Trialists’ (ATT) Collaboration undertook meta-analyses of serious vascular events, including myocardial infarction, stroke, or vascular death, and major bleeding events in six trials studying the long-term use of aspirin for both primary and secondary prevention. They found that, in the primary prevention trials, long-term aspirin use yielded a 12% reduction in serious vascular events, due mainly to a reduction in non-fatal heart attack. However, aspirin use also increased major gastrointestinal and other bleeds. The researchers found that the main risk factors for heart disease were also risk factors for bleeding events due to aspirin use.


Based on these meta-analyses, the researchers concluded that, in primary prevention without previous disease, aspirin was of uncertain net value because the benefit in reduction of occlusive vascular events had to be weighed against the increased risk of major bleeding. They remind health care providers that the risk of heart disease can also be reduced by lowering cholesterol and blood pressure, and the drugs used to reduce these risk factors may be safer than aspirin.



The Lancet. 2009;373:1849-1860.

Created on: 06/08/2009
Reviewed on: 12/23/2009

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