Aspirin may cause more harm than benefit in preventing coronary heart disease

June 29, 2000

Determination of who may derive most benefit from aspirin in primary prevention : subgroup results from a randomised controlled trial

Taking low dose aspirin as a preventive measure against coronary heart disease may result in more harm than benefit in some men, according to a study in this week's BMJ.

Researchers at the Wolfson Institute of Preventive Medicine in London identified over 5,000 UK men, aged between 45 and 69 years, who were at increased risk of coronary heart disease but had not previously had heart trouble. The men had been randomly divided into four different treatment groups to accurately establish the effect of aspirin.

The authors found a greater beneficial effect of aspirin in men with low rather than high blood pressures, not only for coronary heart disease but also for stroke. Men with higher pressures may derive no protective benefit from aspirin but will risk possible serious bleeding, suggest the authors. They add that, even in men with low blood pressures, the benefit does not necessarily outweigh the risk of bleeding.

Given the widespread use of aspirin for the prevention of coronary heart disease, these findings have important implications for clinical practice, although further trials are needed to confirm the results, say the authors. What is certain, they conclude, is the importance of controlling blood pressure for those in whom the preventive use of aspirin is being considered. Men who have previously had heart trouble and strokes and are taking aspirin should continue to do so.
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Contact (via Carolan Davidge, MRC Press Office):

T W Meade, Director, MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London EC1M 6BQ. email: carolan.davidge@healthoffice.mrc.ac.uk

BMJ

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