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Should healthy people take aspirin to fight heart disease?
The concept has been controversial and the medical opinion mixed.
However, a review of scientific data on the subject on Tuesday showed that the benefits are minimal and are offset by a corresponding increase in bleeding risk.
Aspirin is an anticoagulant that can help prevent clots that can lead to a heart attack or stroke. But aspirin also increases the risk of hemorrhage in the brain, stomach and intestines.
"Considering all the evidence, the cardiovascular benefits badociated with aspirin were modest and also balanced by major bleeding," says the report in the journal of the American Medical Association.
The meta-badysis examined 10 previous studies involving a total of more than 164,000 people aged 62 on average.
Comparing aspirin users to those who do not take it, the researchers found "significant reductions" in stroke, heart attack and death from cardiovascular disease among those who took anti-inflammatory drugs. 39; aspirin.
The use of aspirin was also linked to an increased risk of "major haemorrhages compared to the absence of aspirin," he said.
Statistically, the benefits were close to the risks.
If 10,000 people without heart disease did not take aspirin for a year, 61 of them would have a heart attack or stroke, explained Kevin McConway, professor emeritus of applied statistics at the University of Ottawa. Open University.
If 10,000 similar people were taking aspirin for one year, 57 of them would have a heart attack or stroke.
"Only four fewer out of 10,000, but it still has some importance given the frequency and severity of cardiovascular disease," said McConway, who did not participate in the study.
According to the World Health Organization, heart disease is the leading cause of death among the world's population, killing 17.9 million people a year, one-third of all deaths.
Disadvantage: bleeding
"The disadvantage is the increase in the number of major bleeds, including bleeding in the skull and brain or significant bleeding in the stomach or intestines," added McConway.
In a pool of 10,000 people not taking aspirin, 16 would have such an event in a year, against 23 among people taking aspirin.
In other words, about seven other major bleeds a year, which McConway described as a "substantial increase", even though the annual risk of bleeding "is still not high".
According to Jeremy Pearson, badociate medical director of the British Heart Foundation, the meta-badysis "updates our knowledge in interesting ways, but does not change the current perspective.
"This confirms that the average risk of harm exceeds the benefit, so the guidelines should not be changed."
Aspirin is not recommended in Britain for the prevention of heart disease.
In the United States, the US Preventative Services Task Force recommends "starting to use low-dose aspirin for the primary prevention of cardiovascular and colorectal cancer in adults aged 50 to 59 years a rate of 10% or more risk of bleeding, have a life expectancy of at least 10 years. "
Cancer benefits are "neutral"
The study also examined the preventive benefits of aspirin in cancer and revealed "no overall badociation between the use of aspirin and incident cancer or the cancer mortality ".
The review highlighted a study that had revealed a 15% reduction in the number of cancer deaths badociated with the use of aspirin after five years of follow-up.
However, the same results were not replicated in a second trial, which followed nearly 500 patients for seven years.
"The results of this study suggest that the badociation of aspirin with cancer outcomes is neutral, with no suggestion of harm or benefit from the current evidence available," the report said. JAMA.
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