Aspirin and heart disease: a final report.

Aspirin and heart disease: A final report

Healthy men aged 50 and over can nearly halve their risk of a first heart attack by taking an aspirin every other day, scientists said this week in the final cardiac report of the widely publicized Physicians' Health Study. Their conclusion differs from the study's preliminary finding that aspirin therapy could also benefit younger men (SN: 1/30/88, p.68).

A research team at Harvard Medical School and Brigham and Women's Hospital in Boston found that physicians who took 325 milligrams of aspirin on alternate days reduced their risk of heart attack by 44 percent compared with a control group taking a placebo. But the study ended before the researchers could ascertain whether aspirin therapy reduced the number of fatal heart attacks.

"We would have had to continue the study past the year 2000" to determine if aspirin saves lives, says team member Julie E. Buring.

She cautions that although the six-year study involved more than 22,000 physicians aged 40 to 84, including some 9,000 men in their 40s, these numbers, are still too small to demonstrate aspirin's potential to prevent the relatively rare occurrence of heart attacks in healthy men under 50. Buring says that in spite of the findings from the physician study, she agrees with a federal task force on disease prevention that doctors should limit preventive aspirin therapy to men aged 40 and over at increased risk for heart attack.

An editorial accompanying the findings in the July 20 NEW ENGLAND JOURNAL OF MEDICINE suggests that because of the study's small number of heart attacks -- 139 among aspirin takers, 239 in the placebo group -- aspirin's reduction of heart attack risk may have more meaning as an absolute number than as a percentage. The 44 percent reduction translates into a decrease of fewer than two heart attacks per 1,000 people each year, the editorial notes. That factor becomes critical in weighing aspirin's therapeutic potential against such possible side effects as increased incidence of hemorrhagic bleeding and ulcers.

"We have to put the percentage in perspective," says editorial coauthor Marc Cohen of Mount Sinai Medical Center in New York City. "Is it worth it to expose 20,000 people to gastric ulcers to improve survival for four people?" He, too, favors reserving aspirin therapy for people at high risk of heart attack.

Buring told SCIENCE NEWS that her team plans to conduct a similar aspirin study in women, using a group of 44,000 nurses.