Aspirin is good for heart-attack prevention, but skip the proton pump inhibitors

Aspirin treatment has become standard for the prevention of heart attacks, particularly among middle-aged and older people at high risk for heart attacks. But taking a low-dose aspirin daily increases the likelihood of gastrointestinal bleeding, so some doctors suggest that aspirin should be taken with another medication -- a proton pump inhibitor -- to reduce the risk of bleeding. A new study, however, has found that adding the proton pump inhibitor isn’t justified for most patients.

Researchers used a mathematical model to compare the costs and outcomes of low-dose aspirin therapy with and without proton pump inhibitors. They found that treatment with aspirin was less costly and more effective than no treatment in men ages 45 and older who had a risk for a heart attack calculated at 10% over the next 10 years. Adding a proton pump inhibitor was not cost-effective for men with an average risk of gastrointestinal bleeding but may be cost-effective for men with a higher risk of bleeding.

Doctors should assess a patient’s risk of bleeding by considering age, any history of gastrointestinal bleeding and use of other medications that increase the risk of bleeding. For these men, proton pump inhibitors may be worthwhile, the authors said.

“This updated analysis supports the role of aspirin for primary prevention of cardiovascular heart disease events in middle-aged men across a range of cardiovascular heart disease and gastrointestinal bleeding risk levels,” the authors wrote. “Increased risk of gastrointestinal bleeding does not reduce aspirin’s net benefit until gastrointestinal bleeding risk becomes quite high. . .”

The study, which was funded by Bayer, was published Monday in the Archives of Internal Medicine.

Related: Frequent use of over-the-counter painkillers carries real risks.

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