Aspirin
beneficial against heart disease in more men than
previously thought
Newswise — Taking aspirin to
prevent coronary heart disease is beneficial and
cost-effective for a wider range of men than is often
recognized, a study from the University of North
Carolina at Chapel Hill has found.
Compared to no
treatment, taking aspirin was less costly and more
effective for preventing heart attacks and other events
in men whose 10-year risk for coronary heart disease was
7.5 percent or greater. At that risk level, 7.5 out of
100 people can expect to have a heart attack or develop
angina in the next 10 years.
Before this analysis,
most experts felt aspirin was beneficial in men with a
10-year risk of heart disease of 10 percent or greater,
said Dr. Michael Pignone, associate professor of
medicine in the UNC School of Medicine's Division of
General Internal Medicine.
"Our analysis suggests
that it is also beneficial for men between 5 percent and
10 percent risk," said Pignone, also a member of the UNC
Lineberger Comprehensive Cancer Center.
The study also showed
that aspirin was not effective for men whose 10-year
risk was below 5 percent, because the chance of adverse
effects from bleeding cancelled the benefit from
prevention of coronary heart disease events.
"There are patients at
higher risk for coronary heart disease who aren't
getting aspirin therapy who could benefit, and there are
also those at lower risk who are taking aspirin but
shouldn't be," Pignone said.
The study also found
that adding a statin, or cholesterol-lowering, drug to
aspirin therapy became cost-effective only when the
patient's 10-year risk for coronary heart disease was
higher than 10 percent.
"People should find
out their cardiovascular risk and make decisions about
preventive treatment based on that risk," Pignone said.
The study, of which
Pignone is the lead author, is published in the March 7
issue of Annals of Internal Medicine.
Tools are
available that patients or physicians can use to
determine an individual's risk for coronary heart
disease, including "Heart to Heart," found at
http://www.med-decisions.com, the
authors said.
The study used
published data from trials of aspirin and statin therapy
to model the cost-effectiveness of the therapies in
middle-aged men who are at varying levels of risk for
heart disease.
"Many trials have
shown efficacy of aspirin or statins, but we wanted to
analyze the efficacy along with the harms, the costs and
effect on quality of life and see how good of a deal
these treatments are," Pignone said.
The analysis factored
in the risk of side effects such as gastrointestinal
bleeding, as well as the reduction in quality of life
that occurs when a patient finds it onerous to take a
pill every day. The study was limited somewhat by the
amount and quality of data available, including limited
data on adverse effects, Pignone said.
"We still need more
research on some of these issues in order to better
guide prevention decisions."
Other authors of the
study are Dr. Stephanie Earnshaw of RTI Health Solutions
in Research Triangle Park; and Dr. Jeffrey A. Tice and
Dr. Mark J. Pletcher, both of the University of
California at San Francisco.
Pignone and colleagues
plan a future analysis of similar data that applies to
women.
The study was
supported by Bayer HealthCare, LLC. Bayer had no role in
collection, interpretation or analysis of the data, the
authors said. Pignone also received support from a grant
from the U.S. Centers for Disease Control and Prevention
to the RTI-UNC Center of Excellence in Health Promotion
Economics.