Evaluating the Use of Aspirin Therapy for Preventing Heart Attacks

Low doses of aspirin have been recommended for some time as a preventive measure for patients at risk for a heart attack, but new research from Oregon State University reveals that aspirin should not be as widely used for this purpose.

Craig Williams, associate professor in the College of Pharmacy at Oregon, and a panel of reviewers are now recommending that low-dose aspirin therapy to prevent heart attacks should be used more conservatively, stating that men younger than 50 and women younger than 60 who have diabetes but no other major risk factors should not use it.

Writing in Diabetes Care, the authors explain that patients with diabetes who were also taking aspirin “experienced a 55% increased [CVD] risk (RR 1.55, 95% CI 1.13—2.14) compared with those without diabetes.” Williams clarified that this newest study specifically relates to younger patients with diabetes.

“The newest studies just weren’t showing adequate benefits for some younger diabetics,” he said, adding that “widespread use of drugs to control blood pressure and reduce cholesterol has lessened the additional benefits of aspirin.” Because there are other options now for people with high blood pressure and high cholesterol, these are the more optimal treatment option, according to Williams, and “there is no evidence that higher doses of aspirin beyond the range of 75-162 milligrams per day have any added value in preventing heart attacks.”

The researchers are conducting further studies with patients with diabetes to determine who, specifically, would benefit the most from aspirin therapy, but Williams highlighted what he called “the larger theme” of this study.

“Use of low-dose aspirin to prevent heart attacks in people who have not already experienced one is probably not as efficacious as we used to believe it was.” Williams said. “With any medication, you have to balance the benefits against possible side effects or risks. But even a baby aspirin has some degree of risk, even though it’s very low, so we have to be able to show clear benefits that outweigh that risk. In the case of young adults with diabetes but no other significant risk factors, it’s not clear that the benefits are adequate to merit use of aspirin.”

Despite these findings, a recent update to the US Preventive Services Task Force still recommends that older adults — men between 45-79 and women between 55-79 — who have risk factors other than diabetes still use aspirin.