Low-dose daily aspirin is no longer recommended as a preventative treatment for heart attacks.

It has long been known that taking low dose aspirin each day reduces the chances of another heart attack, stroke, or other heart problem in people who have ever had one, but the risks do not. do not offset the benefits for most other people of the guidelines.

People without heart disease who take aspirin daily may reduce their risk of heart attack or stroke, but a new study confirms that they also have an increased risk of serious internal bleeding.

Although it has been used for over a century, the value of aspirin in many situations still remains unclear.

Doctors may consider aspirin in some high-risk elderly patients, such as those who have difficulty lowering their cholesterol or managing their blood glucose, as long as there is no increased risk of internal bleeding, according to the recommendations. from the Journal of the American College of Cardiology say.

European guidelines recommend not using anticoagulant treatments such as aspirin at any age.

"Clinicians should be very selective in prescribing aspirin to people not suffering from known cardiovascular disease," said Dr. Roger Blumenthal, a cardiologist with Dr. John Hopkins, who co-chaired the new guidelines. . "It's much more important to optimize lifestyle and control blood pressure and cholesterol than to recommend aspirin."

"For the most part, we are now much more effective at treating risk factors such as hypertension, diabetes and especially high cholesterol," said Dr. Kevin Campbell, North Carolina cardiologist at CNN. . "This makes the biggest difference, probably reversing any previously perceived benefit of aspirin in primary prevention."

Campbell said he "would advocate a healthy lifestyle, quitting smoking and changing risk factors before even considering aspirin treatment in a patient without known cardiovascular disease."

However, aspirin can save the lives of all people who have suffered a stroke, heart attack, open heart surgery or inserted stents to open clogged arteries. "Ultimately, we need to individualize the treatment of each patient according to his particular situation," Campbell said.

In some of the latest studies, which have been the longest and longest to test for daily blood haemorrhage in people who have not yet heart disease or blood vessel problem.

One of them found that aspirin did not prevent first strokes or heart attacks in people at moderate risk, due to several health risks, such as smoking, high blood pressure or high cholesterol.

Another aspirin tested in diabetics, more likely to develop or die from heart problems, revealed that the modest benefit it brought was offset by an increased risk of serious bleeding.

American doctors have long advised adults who have not had a heart attack or stroke but who are at high risk of taking these tablets to take a daily pill of aspirin, an approach known as primary prevention name.

Even though it is clearly established that aspirin is effective for this purpose, many doctors and patients have been reluctant to follow these recommendations because of the risk of rare but potentially life-threatening internal bleeding.

In one study, people taking aspirin daily had an absolute risk of heart attack, stroke or death from cardiovascular causes 0.38% lower than that of people not taking it. drug.

However, aspirin was also badociated with an absolute risk of severe internal bleeding of 0.47%.

Aspirin has not helped prevent cancer as we had hoped.

And fish oil supplements, also tested in the study of diabetics, have not helped.

"The results demonstrate that there are cardiovascular benefits, but that they go hand in hand with increased risks of serious bleeding," said Dr. Sean Zheng, lead author of the King & King's study. College London and Imperial College London.

"Doctors around the world are very uncertain about the prescription of aspirin," said a study leader, Dr. Jane Armitage of Oxford University. "If you're healthy, it's probably not worth it."