3 September 2018 Blog Post: New Research in August on "Baby" Aspirin

In the past when patients have asked me about the role of a daily low dose or “baby” (81mg) aspirin in preventing a first heart attack or stroke, I have referred to it as “my desert island drug.” To illustrate its relative usefulness, I have gone on to say, “if you are on a desert island, and wanted to take one drug, then it could be a baby aspirin. Sufficient to reduce your risk of heart attack and stroke and at a low enough dose that if you fall out of a coconut tree, then you won’t bleed.”
The largest randomized, controlled clinical trial of its kind was undertaken to evaluate utility of daily aspirin in preventing a first cardiovascular event (i.e. fatal cardiovascular event, non-fatal heart attack, unstable cardiac rhythm or TIA/stroke) among more than 12,500 participants considered to be at moderate cardiovascular risk. Participants were randomly allocated to receive a 100 mg enteric-coated aspirin tablet daily or placebo. The were followed for, on average, 60 months. The study was sponsored by Bayer.

When considering all cardiovascular events combined, a daily aspirin showed no significant effect. The primary endpoint occurred in 269 (4.29%) individuals in the aspirin group versus 281 (4.48%) in the placebo group.

Of interest, aspirin did reduce the risk of total and nonfatal heart attacks. Aspirin accounted for an 82.1% reduction in these events for those aged 50-59 years of age and and a 54.3% reduction in the 59-69 age group. There was no effect of aspirin use on risk of stroke.

Bleeding was relatively infrequent, and when it occurred, was mild and most commonly from the GI tract – 61 (0.97%) individuals in the aspirin group versus 29 (0.46%) in the placebo group. Other commonly reported side effects of aspirin were indigestion, nosebleeds, gastroesophageal reflux disease, and upper abdominal pain.

So it looks as if I will need to amend my “desert island” advice to exclude any risk reduction in stroke. And 1% of you may get a GI or nose bleed falling out of the coconut tree…

In an equally fascinating study published earlier in the month, Canadian researchers suggested that a low dose daily aspirin could reduce HIV susceptibility. So the aspirin story continues on – a century after becoming available.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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