Aspirin Therapy for Heart Disease, Stroke Prevention Not for Everyone

Many people who have never had a heart attack or stroke take an aspirin every day to lower their risk for these events.

While some may benefit, for many others the benefits appear to be outweighed by an increased risk for potentially serious and even life-threatening bleeding, a new study shows.

Researchers analyzed data from nine large studies, including three published since 2007, which followed participants for an average of six years.

Aspirin therapy was not associated with a reduction in deaths due to heart attack and stroke, but it was associated with a significant increase in risk for bleeding, says researcher Kausik K. Ray, MD.

“The benefits of aspirin therapy are clear for patients who have a history of heart attack or stroke,” Ray says. “This is not the case, however, for patients who may have risk factors for [heart disease and stroke] but have no such history.”

The analysis included more than 100,000 people who had never had a heart attack or stroke and participated in trials in the United States, Europe, and Japan.

About half the participants took either low-dose (75-100 milligrams) or full-strength (300-500 milligrams) aspirin daily or every other day. Everyone else took placebos.

Over an average follow-up of six years, about 1,500 nonfatal and 500 fatal heart attacks and about 1,500 fatal and nonfatal strokes were recorded.

Aspirin therapy was associated with a 10% decrease in heart attacks and strokes, which was largely explained by a reduction in nonfatal heart attacks, Ray says.

But patients on the aspirin regimens were also 31% more likely to experience significant bleeding.

Aspirin therapy has been shown in several previous studies to be associated with a reduced risk of death from cancer, but the association was not seen in the new analysis, which was published in the Archives of Internal Medicine.

Ray and colleagues from the Cardiac and Vascular Sciences Research Center at St. George’s University of London conclude that for many patients with no history of heart attack or stroke, aspirin adds little to strategies proven to reduce heart disease and stroke risk.

These strategies include drug treatments that regulate blood pressure and cholesterol, and lifestyle changes such as smoking cessation, weight loss, and regular exercise.

The researchers add that more study is needed to identify patients who have not had heart attacks or strokes for whom the benefits of aspirin therapy outweigh the risks.

“In the absence of such information, a reappraisal of current guidelines appears to be warranted, particularly in countries where a large number of otherwise healthy adults are prescribed aspirin,” the researchers write.

Cardiologist Samia Mora, MD, of the Brigham and Women’s Hospital and Harvard Medical School, says patients need to discuss their individual risk for heart attack and stroke with their doctor before embarking on an aspirin therapy regimen.

In an editorial published with the paper, Mora writes that for low-risk patients the data “argue against the routine use of aspirin for primary prevention of [heart disease and stroke].”

“Right now, we really need to assess risk on a case-by-case basis,” she says. “For someone with a strong family history of heart attack or stroke, for example, a daily aspirin may be warranted even in the absence of other risk factors.”

New York University cardiologist Nieca Goldberg agrees that patients should always discuss their individual risks with their doctor before starting aspirin therapy.

Cardiac Arrest Risk Low in Marathons, Study Finds

 When a runner dies during a marathon because their heart stops, it's big news -- and can be scary to the 2 million runners who participate in U.S. long-distance events each year.

However, the risk of cardiac arrest during long-distance races is relatively low, according to new research. A cardiac arrest occurs when the heart stops beating, and it's generally more serious than a heart attack.

Over a 10-year period, 59 runners, or 1 in 184,000 participants in half or full marathons, suffered cardiac arrest, says researcher Aaron Baggish, MD, associate director of the Cardiovascular Performance Program at Massachusetts General Hospital. He is also the cardiologist for the Boston Marathon. There were nearly 11 million participants during the decade studied.

Those who run a full marathon, 26.2 miles, are at higher risk of heart problems than those who run the half, he found. Men are at higher risk than women.

"It appears the half marathon is safer and better tolerated than the marathon," says Baggish. "Most of the problems we saw were marathon-related."

The study is published in The New England Journal of Medicine.

The new research, believed to be the first comprehensive study of marathon and half-marathon participants, may change the stereotypes. "The public perception is that marathons and half marathons are dangerous endeavors," Baggish says.

Veteran runners, on the other hand, may feel overly protected because of their healthy lifestyle, he says.

While the number of race-related deaths due to cardiac arrest has risen, "the increase in the number of cardiac deaths only parallels the increased number of participants," Baggish tells WebMD.

In 2000, fewer than 1 million participated in U.S. long-distance races. In 2010, 2 million did.

Baggish and his team tracked cases of cardiac arrest in half marathons and marathons in the U.S. from Jan. 1, 2000, through May 31, 2010.

They interviewed survivors or the family members of those who died. They reviewed medical records. They looked at post-death data.

Forty of the cardiac arrests occurred during marathons; 19 during half marathons.

Eighty-six percent of those who suffered cardiac arrest, or 51 of the 59, were men. The average age of those who had cardiac arrest was 42. Cardiac arrest was most likely to occur during the last quarter of the event.

Of those 59 cardiac arrests, 42 were fatal. Baggish says that death rate -- 71% -- is better than the 92% rate generally found when cardiac arrest occurs, when people are at home or in other isolated areas.

He credits the medical services at races and bystanders who performed CPR with this higher survival rate.

Next, Baggish looked at the causes. He had enough medical information to evaluate the cause for 31 of the 59 runners. An abnormal thickening of the heart muscle, known as hypertrophic cardiomyopathy, was often the confirmed or probable cause of death.

Among those who survived, underlying heart disease was the most common problem. Baggish found the risk of cardiac-related death over the 10-year period was 1 per 259,000 long-distance runners. Other research suggests that this risk is equal to or lower than that for other physical activity such as triathlons, college athletics, and jogging, he says.

Catching Germs at School And In Sports

Moms know it’s hard enough to keep kids away from germs when they’re at home. But during school hours, your little ones come across all different kinds of germ-filled situations. So how do you go about teaching your kids to avoid germs during the school day, or while they’re playing sports afterward?

“We live in a world of germs and you’re going to be exposed to them; it’s just a matter of trying to protect yourself as much as you can,” says Sandi Delack, RN, BSN, M ED, NCSN, a practicing school nurse in Rhode Island and president-elect for the National Association of School Nurses. “There are things you can do to minimize your risk,” says Delack, like washing your hands, and keeping your hands out of your mouth, eyes, and nose.

However, it takes a lot of repeating to get that message into kids’ heads, Delack says. “They have to hear it over and over, and they need to hear it at school, they need to hear it at home.” The earlier kids get the message the easier it’ll be on parents. “I’ll see kids walking down the hall all the time with the tie to their sweat shirt or their chain in their mouth and I’ll say, ‘Do you know how many germs are on that? Take that out of your mouth!’”

The bus ride to and from school is fraught with opportunities for close encounters of the germ kind. Delack says parents should be sure to tell kids that this is one time sharing isn’t a good thing -- so don’t share drinks or snacks; older kids should even be wary of talking on friend’s cell phone (or using it to text) if that friend has a cold.

Kids should also try to keep book bags off the floor, Delack says. And, parents need to set up a space far away from the kitchen counter or kitchen table -- anywhere food is prepared -- to stash school bags when kids get home.

So many classroom activities involve hand-to-hand contact: things like passing papers back down the row, or sharing pencils, pens, scissors and other tools. But it’s not touching things that belong to other kids that’s the problem, it’s what kids do after they touch an item. “The important part is they’re not putting their hands in their mouth and in their nose,” Delack says. That’s how germs have a chance to enter the body and that’s really how you get sick.

To counteract bacteria, many teachers purchase bulk supplies of hand sanitizer and tissues, then make them available to students throughout the year. Some schools ask each student to bring a box of tissues and a bottle of hand sanitizer and create the year’s supply that way. The key for parents is to remind kids to go get a tissue from the box or use the hand sanitizer when they need to.