It has become a fashion to prescribe baby aspirin (50-75 mg) daily for healthy people above the age of 30 for preventing a heart attack. A couple of decades ago Professor Cleland, a cardiology professor at the Southampton University had analysed the data and had clearly shown that while aspirin might or might not prevent non-fatal heart attacks, it definitely increases fatal cerebral haemorrhagic stroke by ten per cent! This did not deter the drug industry from coming out with their infamous “poly-pill” with the same aspirin in addition to rat doses of many other drugs in a single pill with propaganda claiming that a daily pill of this cocktail will keep death at a distance. Thank God that poly-pill remained a non-starter.
Man is dreaming of immortality always and the industry caters to that dream. George Bernard Shaw in his classic, Doctor’s Dilemma, did emphasise: “do not try to live here for ever, you will certainly not succeed”.
A recent excellent study by the Southampton University and the Maastricht University in the Netherlands found that taking aspirin daily may lead to increased odds of heart attacks by 190 per cent! The study also revealed that a class of drugs called direct oral anticoagulants were also tied to increased odds of heart attack in patients with atrial fibrillation. The findings echo the guidance issued by NHS watchdog NICE in 2015 which said aspirin does more harm than good for AF patients. Atrial fibrillation affects up to 900,000 patients in England and causes their hearts to beat fast and irregular, greatly increasing the risk of stroke and early death. But as many as one in seven—up to 1,20,000 patients—are taking aspirin even though it isn’t very effective and may itself cause a stroke.
Look at this irony. An earlier study in 2016 did say that aspirin is a panacea for elderly people to live longer! Older Americans who take a low dose of aspirin every day will drastically cut their risk of contracting heart disease or cancer, a new study claims. "Although the health benefits of aspirin are well established, a few people take it," said David B Agus, the lead author of the study. The authors claim “multiple health benefits and a reduction in healthcare spending from this simple, low-cost measure that should be considered a standard part of care for the appropriate patient.”
The long-term benefits of low-dose, daily aspirin were questioned this year after conflicting guidelines were published by the US Preventive Services Task Force, a government-backed panel of experts, and the US Food and Drug Administration. The task force issued updated aspirin guidelines that declared the clinical benefit of aspirin.
However, the FDA was concerned that some patients, particularly those 60 and older, face an increased risk of stroke and bleeding—both gastrointestinal and in the brain—if they take aspirin daily. However this study was not a prospective one and was derived from observations done by different sets of examiners at different times and with different entry criteria and is not as reliable as the Southampton study.
There was a more detailed study from Scotland published in 2010 in the Journal of the American Medical Association which did show aspirin in bad light. Another study revealed that regular aspirin intake did not decrease the likelihood of suffering heart attack in at-risk patients. Scottish researchers found that high-risk patients who took aspirin daily had similar stroke and heart attack rates as those on placebo treatment. About three years ago, Bayer AG requested to label aspirin as a heart attack prevention drug. Based on the 2010 Scottish study it was denied by the FDA. The FDA has also cautioned patients taking aspirin with blood thinners. Other serious effects associated with aspirin intake include internal bleeding, peptic ulcers, asthma, and kidney disease.
Although there are any more studies on aspirin these three show how medical research throws up uncertainty as its only certainty. A layman would be floored by this kind of reductionist research. So, before one relies on these studies, especially the ones that support a common drug for uncommon indications, one has to see who funds that research.
Of these three studies the Scottish and Southampton studies were prospective done on NHS patients and not much money changed hands but the American studies are all money-based studies where research simply means getting more funds, writing more papers and, fattening their CVs. Even if one goes by democratic principles there are more reliable studies that show aspirin in bad light.
I would be happy to accept the Southampton study for the time being as the best guidelines for aspirin treatment. I would go one step further to warn doctors to be very parsimonious in prescribing NSAIDS (Nonsteroidal anti-inflammatory drug)for simple upper respiratory infections as the latter in the long run could precipitate a stroke or heart attack. Many young people get a heart attack probably due to NSAID use earlier, even if they had used it five years before. There were some studies suggesting inflammation as the cause of vascular diseases—the new target for new drugs from industry.
I have a hunch that it is the NSAIDS that must have connected the two. One cannot get better with reductionist thinking in a holistic human being with his mind in the driving seat. In the medical field where wise people insist on evidence, we do not have a scope to gauge the human mind. Until then, all our reductionist studies remain only tentative, but caution is our wiser bet.
Logically chemical drugs cannot be used for preventing any disease when they have potentially dangerous side effects. Using them for treatment in a desperate situation is logical but not for prevention.
Prof B M Hegde
Cardiologist and former vice chancellor of Manipal University
Email: hegdebm@gmail.com