Q: Now that a big study has failed to show taking baby aspirin can help prevent a first heart attack or stroke, should people keep taking it?
A: Don't make any changes before you talk to your doctor, two local medical advisors are urging.
The study, published this week in The Lancet, involved more than 12,000 patients over a five-year period to assess how safe and effective it is for patients considered to be at moderate risk of a first cardiovascular event to take an aspirin on a preventive basis. Moderate risk is considered to be a 10 percent to 20 percent risk in a 10-year period.
The study didn't prove aspirin beats a placebo among people of moderate risk. However, the rate of gastrointestinal bleeding — while still considered to be low — was double in the aspirin group over the placebo group — 0.97 percent for the aspirin-takers versus 0.46 percent in those who took a placebo.
The fact that the rate of cardiovascular events was lower than expected is probably linked to how patients in the study were being managed on other medications, so findings may be more representative of low-risk, rather than moderate-risk people, the researchers said.
Samantha McCauley, a cardiology nurse practitioner at Carle, urged any patients considering either starting or discontinuing daily baby aspirin to consult with their doctors first.
The benefits of aspirin to help prevent additional heart events, for example, are well-established, McCauley said.
Dr. Ben Johnston, medical director of convenient care at Christie Clinic, said he wouldn't be inclined to make a change related to aspirin therapy for now based on this study. And patients can wait at least a few months to talk to their doctors about whether they should stop taking aspirin, he said.
That's because more detail about this study will become known over the next three to six months, and it's best to wait until more analysis has been done, he said.
Meanwhile, the downside to aspirin is fairly minimal, Johnston said, and "it's been the standard of care for some time."
"In a nutshell, I wouldn't change any of my practice right now," he said.
One reason he and others give for not making the aspirin decision without a doctor's advice is people may not necessarily know what their risk level for heart disease or stroke actually is.
One way to find out is to use an online tool from the American College of Cardiology and American Heart Association at cvriskcalculator.com, McCauley said.
You'll have to answer questions about your age, gender, race, blood pressure, cholesterol level, whether or not you have diabetes, are a smoker and if you're being treated for high blood pressure for your 10-year risk level to be assessed.
Once you undergo the online screening, you should still discuss what you learn with your doctor before starting or quitting aspirin, McCauley advised.
The U.S. Preventive Services Task Force advises aspirin therapy for the primary prevention of cardiovascular disease and colorectal cancer for people ages 50-59 if they have a greater than 10 percent 10-year disease risk rate, if they're not at a greater risk for bleeding and are willing to take daily low-dose aspirin for 10 years.
For adults in their 60s, the group says the decision to initiate low-dose aspirin under the same circumstances and at the same risk should be an individual one.
If you're younger than 50 or 70-plus, the evidence is insufficient to assess the benefits and harm from taking daily aspirin.