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Confusing recommendations about long-term ASA intake
Aspirin is one of the best known drugs. In addition to the analgesic effect, the active ingredient acetylsalicylic acid (ASA) is said to have a certain protective effect against heart attacks and strokes, since it thins the blood and inhibits the formation of blood clots. However, long-term aspirin intake also entails certain risks. Health experts clarify when long-term intake can make sense.
American guidelines for the prevention of cardiovascular diseases recommend taking aspirin for people aged 40 to 70 who are at higher risk of a first cardiovascular event. For people over 70 years of age, the guidelines do not recommend long-term use.
Better guidelines required
The German Heart Foundation also says that with ASA, the risk of these fatal events can be reduced even for people who have no risk factors for a heart attack or stroke. But the benefits for healthy people are so small that the risk of possible side effects usually outweighs them. This is also underlined by several recent studies that suggest that the damage to long-term ASA intake is often greater than the benefit.
Medical professionals and patients are now increasingly confused, as there are no longer any clear recommendations as to who benefits from long-term intake and who does not. A team of health professionals from Florida Atlantic University’s Schmidt College of Medicine, the University of Wisconsin School of Medicine and Public Health, Harvard Medical School, and Brigham and Women’s Hospital clear up the confusion and ask for more specific guidelines.
Aspirin is recommended if you have a heart attack
"All patients who have had an acute heart attack should receive 325 milligrams of regular aspirin immediately afterwards to reduce their mortality rate and the subsequent risk of heart attacks and strokes," emphasizes Dr. Charles H. Hennekens, the senior academic advisor at Schmidt College of Medicine. In addition, according to Hennekens, long-term survivors of previous heart attacks or occlusive strokes should be prescribed aspirin over the long term unless there is a specific contraindication.
ASS is complicated for prevention
In primary prevention of cardiovascular events, however, the relationship between the absolute benefits and the risks of aspirin is far less clear. In apparently healthy people, the absolute benefit must therefore be weighed up individually against the absolute risk.
Increasing stress from cardiovascular diseases
The experts emphasize that the increasing burden of cardiovascular diseases in industrialized and developing countries requires a more comprehensive therapeutic change in lifestyle and the concomitant use of drug therapies with proven benefits in the primary prevention of heart attack and stroke.
Suitable preventive measures include smoking cessation, weight loss and increased daily physical activity. Medicines for blood pressure control, for example, are suitable for medicinal support.
When is aspirin suitable for prevention?
"If the magnitude of the absolute benefits and risks is similar, the preference of the patient becomes increasingly important," said Hennekens. This also includes considering whether the prevention of a first heart attack or stroke is more important for those affected than the risk of gastrointestinal bleeding (see: Constant use of aspirin increases the risk of internal bleeding).
ASA for people with metabolic syndrome?
Hennekens gives people who suffer from the metabolic syndrome as an example - a combination of overweight, high blood pressure, high cholesterol and insulin resistance. The risk of a heart attack or stroke occurring in these people is similar to that in people who have already had a heart attack.
General guidelines unlikely
Hennekens concludes: "General guidelines for aspirin in primary prevention do not seem to be justified." Instead, the benefits and risks would have to be weighed up individually in each individual case. (vb)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
- German Heart Foundation: ASA against heart attack only advisable for certain people (accessed: February 18, 2020), herzstiftung.de
- Florida Atlantic University: Researchers challenge new guidelines on aspirin in primary prevention (published: February 17th, 2020), fau.edu
- Alexander Gitin, Marc A Pfeffer, David L. DeMets, Charles H. Hennekens: Aspirin in primary prevention needs individual judgments; in: American Journal of Medicine, 2020, amjmed.com