Tuesday, March 17, 2009

An aspirin a day does keep the doctor away.

Though not picked up that much by the print media, you have probably seen on the news or the web new recommendations for taking daily aspirin to prevent heart attacks and strokes. You may know about the potential heart benefits from aspirin, since the folks at Bayer continue to remind the public of this. However, the benefits are real, and newer recommendations should help.

The new recommentation from the U.S. Preventive Services Task Force which is published in the Annals of Internal Medicine is that most men between 45 and 79 and most women between 55 and 79 should take an aspirin a day.

For men, aspirin was found to prevent heart attacks, and for women it was found to prevent strokes. The optimal dose of aspirin is not clear, but benefit was seen as low as 75 mg was about as effective as higher doses. Thus, a generic baby aspirin a day is probably the cheapest and most effective dose.

The reason why everyone should not take this is that even aspirin has some side effects, mainly gastrointestinal bleeding. GI bleeds can be serious, require hospitalizations, surgery and can even cause death. The older you are the higher your risk for heart attack and stroke, but the higher you risk is for GI bleeds. For example, if you took 1000 65 year old women, each with about a 7% risk of having a stroke, your would probably prevent 12 of them from having a stroke, but cause and equal number of GI bleeds. Thus, even if you fall within the age range, if your risk of heart attack and stroke is low, aspirin may not be for you. Patients older than 79 were not routinely recommended for this because of the higher risks of GI bleeds, even though some patients older than 79 may be good candidates. Similarly, people younger than 45 were not recommended because there was not clear enough evidence of benefit.

If you are not taking an aspirin a day, and think you might benefit, please discuss this with your doctor.


Brian Wolstenholme, Pharm.D. said...

It's always a good idea to mention the interaction with NSAIDS when talking about aspirin regimens- something patients rarely think about.

Brian Wolstenholme, PharmD, CGP, FASCP

Anonymous said...

Isn't the NTT unreasonably high for aspirin therapy?