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Aspirin not effective in primary prevention

Taking aspirin every day does not help prevent heart attack or stroke in patients who do not have arterial disease

Taking aspirin every day does not help prevent heart attack or stroke in patients who do not have arterial disease, according to data presented at the European Society of Cardiology (ESC) Congress in Barcelona on Sunday 31 August. The results of the Aspirin for Asymptomatic Atherosclerosis (AAA) study show: "No statistically significant difference in primary endpoint events between those subjects allocated to aspirin or placebo."

Antiplatelet drugs, such as aspirin, are effective in preventing stroke and heart attack in patients who already have arterial disease but the evidence does not support their use in primary prevention.

The AAA study randomised 3,350 people in Scotland with ankle brachial index (ABI) under or equal to 0.95 - demonstrating absence of peripheral artery problems - to take a daily dose of 100 mg dose of aspirin or a placebo. The average follow-up time was 8.2 years. In the aspirin group, 181 people had an initial coronary event or stroke, or underwent a revascularisation procedure; in the placebo group this number was 176.

Professor Gerry Fowkes, one of the lead researchers, said: "It is possible that in the general population, aspirin could produce a smaller reduction in vascular events than this trial was designed to detect, but it is questionable whether such an effect, together with aspirin related morbidity, would justify the additional resources and healthcare requirements of an ABI screening programme."

Professor Peter Weissberg, medical director at the British Heart Foundation (which part-funded the research) said: "The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits."

1st September 2009


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