The role of acetylsalicylic acid in preventing heart problems is being viewed more and more critically. A new study now indicates that the aspirin ingredient could even be counterproductive and reduce the pumping ability of the heart.

From January 1988 at the latest, the daily intake of low-dose acetylsalicylic acid (ASA) has been seen as a means to reduce the risk of heart attacks. But while many millions of people have been using the aspirin ingredient since then, its value is being viewed more and more critically by scientists. A new European-American study now speaks of a significantly increased risk of cardiac insufficiency when taking ASA.

Observation period over 5 years

“This is the first study that reports that people with a risk factor for developing chronic heart failure develop heart failure more often when they use aspirin than without the use of aspirin,” said Blerim Mujaj from the University of Freiburg about the results scientific study that has now appeared in the journal “ESC Heart Failure” of the European Society of Cardiology.

People who smoke, suffer from obesity or high blood pressure, have high cholesterol levels, are diabetic or already have cardiovascular disease, are advised to take 50 to 100 milligrams of acetylsalicylic acid daily. This is supposed to prevent blood clots from forming during a heart attack or stroke.

For the study, the scientists analyzed the data from 30,827 heart failure patients in Western Europe and the USA. The average age was 67 years. 7698 test subjects took aspirin, that was 25 percent of the patients. The observation period was 5.3 years. 1330 of the patients developed a pumping weakness of the heart.

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Risk increased by 26 percent

When evaluating the information, the scientists mathematically compensated for other risks. The result: “The intake of aspirin was correlated with a 26 percent increased risk of heart failure, regardless of other factors.” The results of the observational study were then checked by individually comparing each person who had reported using ASA with a control person who was not taking ASA. This analysis also showed a risk increase of 26 percent. Even in 22,690 study participants without a diagnosed cardiovascular disease, a 27 percent increased risk of heart failure was registered when taking ASA.

According to the German cardiologist Mujaj, large international studies with allocation to comparison groups should now verify these results by chance in order to be able to make final statements. Until then, care should be taken when prescribing ASA.

In any case, tens of millions of people around the world are likely to take ASA to reduce the risk of a first heart attack. This is called primary prevention. This procedure was based on scientific findings from the “US Physician’s Health Study”, which had caused a sensation worldwide from January 1988. 22,000 healthy doctors had participated in the study. They swallowed a tablet with 325 milligrams of the active ingredient or every other day Placebo: After about five years it was found that the risk of heart attack was 47 percent lower with ASA prophylaxis.

USA wants to restrict acetylsalicylic acid

In the meantime, however, the value of acetylsalicylic acid as a means of preventing a first heart attack or even a stroke is viewed increasingly critically. The US Preventive Services Task Force, which advises the US Department of Health on disease prevention, now wants to restrict the use of ASA.

“In 2016, the task force advocated generous use of ASA in so-called primary prevention. All adults aged 40 to 59 who have a ten-year risk of cardiovascular disease of ten percent or more and none If you have an increased risk of bleeding, it was advised to take ASA daily, “said the German Ärzteblatt recently. In the United States, nearly a quarter of people over 40 swallow low-dose aspirin.

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In Europe, cardiologists have always been much more cautious in this regard. Acetylsalicylic acid blocks the function of platelets, which prevents thrombus formation. On the other hand, the risk of bleeding increases.

According to the draft for new recommendations of the US committee, the decision on whether to take ASA for 40 to 59 year olds should be made individually in the future. From the age of 60, ASA is no longer recommended in the prevention of heart attacks and the like. The risks from bleeding could be greater than poor protection against cardiovascular disease.

Correlation increases with age

The background: the risk of potentially dangerous bleeding increases with age. According to an analysis of eleven studies with almost 135,000 subjects, for example, the use of acetylsalicylic acid was 31 percent more likely to cause dangerous cerebral haemorrhage. Other bleeding is about half more common.

Experts pointed out that since the 1980s, many new ways of preventing heart attacks or strokes have proven themselves. These include, for example, the widespread use of cholesterol-lowering drugs and the effective treatment of high blood pressure. On the other hand, this reduces the importance of ASA.

However, it was only on August 29th of this year that the British medical journal “The Lancet” published a study according to which a combination pill consisting of a cholesterol-lowering drug, a blood pressure drug and low-dose acetylsalicylic acid is more effective than one in the primary prevention of cardiovascular incidents ” Polypill “without ASA.


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