Test Confirms Aspirin Can Cut Heart Risk

An aspirin every other day can cut the risk of heart attack in half for men over 50 and provide even greater benefits for those at highest risk of heart attack because they smoke or have diabetes, high cholesterol levels or high blood pressure, according to the final results of a landmark study published today.

The study, published in the New England Journal of Medicine, also suggested that the benefits can be achieved without an increased risk of stroke.

The findings have broad implications because an estimated 1.5 million Americans suffer first heart attacks each year and a third of them die as a result.

“Those with highest risk have the highest benefits,” Dr. Charles H. Hennekens of Harvard Medical School, the cardiologist who directed the study, said in a telephone interview. The report “suggests that aspirin is likely to be of benefit across a wide range of people.”

Preliminary results from the five-year study of 22,071 male physicians were highly publicized in January, 1988, when the study was prematurely terminated because the benefits of aspirin therapy were so clear cut. At that time, three-quarters of the patients who had been receiving a placebo--a sugar pill--began to take aspirin regularly.

The new report, based on extended observations of the physicians and a more thorough analysis of the data, “basically confirms the findings mentioned in the original report,” provides new details about the risks of various subgroups of patients and alleviates concern about aspirin and strokes raised in the preliminary report, Hennekens said.

Lesser benefits were observed in men under 50 and among those who were already at low risk of suffering such attacks. Among all men in the study between the ages of 40 and 85, those taking aspirin had a 44% reduction in heart attacks.

The preliminary report had suggested that regular use of aspirin, which reduces the tendency of blood to clot, might increase the risk of stroke, particularly those caused by excessive bleeding in the brain. The new study continued to show that slightly more of those who received aspirin suffered strokes, but the increase was not statistically significant.

The two groups also had virtually identical rates of gastrointestinal upsets, but the aspirin group had a slight increase in the incidence of ulcers. Both conditions are frequently associated with higher rates of aspirin use.

“We have to conclude that aspirin is likely to be of benefit in those whose risk is high enough to warrant (risking) the side effects of the drug,” Hennekens said.

In an editorial in the same issue of the journal, Dr. Valentin Foster and his colleagues at the Mt. Sinai Medical Center in New York City wrote that “it now seems reasonable to advocate the use of aspirin . . . in patients with clinical manifestations of coronary disease.”

But they and others warned that those at high risk of heart attacks should not simply rely on aspirin instead of attempting to reduce their risk factors by cutting down smoking or reducing their cholesterol intake. Cardiologists also cautioned that the decision to take aspirin regularly should be made in conjunction with a physician.

“We are specifically not advocating that all Americans take aspirin to prevent a heart attack,” said Dr. Myron Weisfeldt, president of the American Heart Assn.

Those who specifically should not take aspirin include individuals with kidney or liver disease, peptic ulcer, gastrointestinal or other bleeding problems and a history of certain types of stroke. Hennekens also cautioned that taking more than one aspirin every other day would not increase the protection from heart attack, but would increase the risk of side effects.

After the preliminary results were published last year, aspirin makers ran advertisements in consumer publications advocating regular use of aspirin in warding off heart attacks. The Food and Drug Administration, however, persuaded them to stop using the ads until the agency had had an opportunity to study the new findings.

Bristol-Myers Products, the manufacturer of Bufferin, which was used in the study, announced Wednesday that it has applied to the FDA for permission to label aspirin to indicate that it helps prevent heart attacks. The FDA is expected to issue new guidelines on aspirin advertising and labeling this fall, according to an agency spokesman.

There is virtually no evidence that aspirin would confer a similar benefit on women, although many physicians think it would. Women were not included in the study because their risk of heart attack is only about 25% that of men, and thus would require a much larger study population.

Hennekens’ group is now seeking funding from the National Institutes of Health to conduct a similar study of the effects of aspirin on 40,000 women nurses.