Does aspirin protect healthy patients from heart attacks?

A new large study published in the recent issue of the Lancet brings this into question.

I believe that the press is misreporting on the findings. What the researchers found that YES aspirin did prevent nonfatal heart attacks. However, patients who took aspirin were also more prone to develope gastrointestinal bleedings.

When aspirin is given to patients for primary prevention, it could be expected to prevent five nonfatal heart attacks but cause three extra gastrointestinal bleeds per 10,000 people treated per year.

In my experience as a Interventional Cardiologist ("heart attack doctor"), most patients that I meet having a heart attack are not on a daily aspirin. Even if they are on a daily aspirin, when they do have a heart attack, its never the "big one" but a small non-life treatening one.

Yes, patients on aspirin do blled more than patients not taking aspirin.

There is no doubt that a daily aspirin is highly protective in patients with established heart and vascular disease.

So what do I take from this.

1. Asprin is highly effective in patients with established heart or vascular disease
2. Aspirin does protect "healthy" patients from heart attacks
3. Patients who take aspirin bleed more than patients who do not
4. Therefore, the risk/benefit ratio needs to be analyzed very carefully for each patient. If a patient has a high risk of GI bleeding with low risk of heart disease, I would recommend staying away from aspirin. If a patient has a high risk of heart disease but low risk of bleeding, I would definitely recommend using aspirin. If the patient has a high risk of bleeding and a high risk of heart disease, I would recommend treating the patient with aspirin but ensure that the patient understands the increased risk of bleeding.