More Confusion Over Aspirin Use?

Recently, the Wall Street Journal (WSJ) posted an article, “The Danger of Daily Aspirin,” that questioned the use of aspirin for prevention of cardiovascular disease and stroke, citing the increased risk for gastrointestinal (GI) bleeding. Although the WSJ article is generally balanced in its discussion about aspirin use, the headline and some comments from the piece add to the confusion about the appropriate use of aspirin for primary prevention.

The WSJ article references a meta-analysis published in The Lancet in May 2009 as evidence for its arguments regarding caution when taking aspirin for primary prevention of heart disease and stroke. But the story really begins in April 2009 when the U.S. Preventive Services Task Force (USPSTF) – the quasi-governmental body that rigorously evaluates the effectiveness of clinical preventive services – reported that regular aspirin use can reduce first heart attacks in men and first strokes in women. The findings from the USPSTF apply to men 45 and 79 years of age and to women 55 to 79. The USPSTF found that aspirin should be used when the benefits outweigh the harms for potential GI bleeding. This straightforward recommendation helped resolve the often confusing messages consumers receive about aspirin use.

Or so it appeared. Little more than a month later, The Lancet study offered a seemingly conflicting conclusion, namely, that the long-term use of aspirin in preventing first heart attacks and strokes is of uncertain net benefit since the potential benefits and harms may cancel each other out.

The study from the USPSTF and the study appearing in The Lancet relied on the same meta-analyses in their research but still came to different conclusions. How could this happen? In layman’s terms, the reason for the seemingly conflicting conclusions appears to be that the authors of the second study gave equal weight to incidents of GI bleeding as to heart attacks and strokes. In contrast, the USPSTF appears to conclude that it is more important to prevent heart attacks and strokes than to prevent gastrointestinal bleeding events.

Upon closer examination, though, the findings of the two studies are far more similar than they appear. Both the USPSTF and the authors of The Lancet study underscore the importance of patients and healthcare providers discussing the benefits and harms of regular aspirin use.

Partnership for Prevention’s Aspirin Task Force – an independent panel made up of some of the nation’s leading experts on aspirin use – carefully reviewed the methodology, findings, and conclusions of this study. The Aspirin Task Force recommended no immediate change in the use of aspirin and aspirin counseling. Its assessment of The Lancet study can be found here.

The decision to take aspirin can sometimes be difficult. It does have a proven track record in preventing first heart attacks and strokes in men and women, respectively, but, like all medications it does have risks. Therefore, as reiterated by the Aspirin Task Force, the key step in the decision-making process is an informed discussion between patients and their healthcare providers to ensure the appropriate use of aspirin. That is not confusing at all.

Rebecca Doigan
Research Fellow and Program Associate
Partnership for Prevention