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Medical guidelines say that daily aspirin is at risk for most healthy people. A new study says that some may benefit

A new study published in the medical journal Annals of Internal Medicine on Monday came to a different conclusion.

The study found that aspirin reduces the risk of heart problems for patients at risk and for some patients without known risk of cardiovascular disease. The researchers concluded that the benefits of aspirin outweigh the damage to bleeding, if you compared the risk of death from a bleeding event compared to the risk of hospitalization or death from a heart event.

At least 12.1% of men and 2.5% of women without a history of heart problems received a net benefit of five years of aspirin treatment, the study found. The percentage benefit increased even more when you compare the risk of two bleeding events with two cardiovascular events.

Researchers calculated this by looking at data from more than 245,000 healthy adults aged 30 to 79 in New Zealand.

"We classified each individual in the study favored by aspirin if the number of events prevented was greater than the number of bleeding events, 1
,000 individuals with the same characteristics as the individual to be treated with aspirin for 5 years," the author said Vanessa Selak, senior lecturer in the epidemiology and biostatistics section of the School of Population Health at the University of Auckland.
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While the authors conclude that aspirin for some people without heart disease "is likely to result in net benefits ", they warn that more search will be needed to see if this applies to people living outside New Zealand. Nor did they look at aspirin use in people older than 79.

The authors of the study make no argument to change the current guidelines, created for the United States by the American College of Cardiology and the American Heart Association.

The study adds that "aspirin is likely to result in a net benefit" that it is "difficult" to give a general recommendation on it.

Kevin McConway, an emeritus professor of applied statistics at The Open University, agrees with their caution.

"The methods for estimating the risk of [cardiovascular disease] and for major bleeding are based on New Zealand data and may give inappropriate figures for the risks in other populations," McConway, who was not associated with the research, told the Science Media Center in Great Britain. "It would be wrong to simply transfer New Zealand's results to other populations without further research."

Similar findings, different interpretations

Previous research has shown that taking a daily low dose of aspirin is associated with an increased risk of bleeding in the skull.
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Dr. Amit Khera, a professor of medicine in the Department of Cardiology at UT Southwestern Medical Center who helped write the latest guidelines from the American Heart Association and the American College of Cardiology regarding aspirin, said these findings are similar to the trio of 2018 studies that used to create the current US guidelines.

Although the results are similar, these studies came to a different conclusion, claiming that a daily aspirin regimen did not provide significant health benefits for older adults and could cause harm. What is very different, Khera said, is the interpretation of the risk of a bleeding event. Unlike the authors of the current study, he thinks the damage is too great.

"This is not a bleeding in the nose, these are serious bleeding events that require hospitalization and transfusions," Khera said.

Still, a new study found that millions of American adults who never had cardiovascular disease still take aspirin.

"It used to be when patients considered using daily aspirin we would generally say yes, sometimes no. Now when people ask, it's a general no, you shouldn't take it, and sometimes it's a yes. It's a much finer balance now, "Khera said. "It can help people who have had heart attacks and strokes, but generally healthy people, for most people, taking aspirin is not an advantage."

Instead, doctors urge patients to adopt healthy lifestyle habits such as not smoking and controlling blood pressure and cholesterol through exercise and diet.

Selak, who wrote the new study, emphasizes the fine line of this decision.

"There is obviously an advantage to aspirin in reducing the risk of events [cardiovascular disease] based on a recently published meta-analysis of all relevant studies of aspirin among people without established CVD," Selak said. "The challenge is that aspirin also increases the risk of major bleeding.

"What our study has shown is that there are people who are likely to benefit from aspirin, taking into account the bleeding injuries, but a personal prediction of benefits and damages is needed to identify these people."

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