How does your doctor help you avoid cardiac events like heart attacks or strokes? Establishing a prevention strategy is important to lessen the risk of such dangerous events. Doctors generally define prevention strategy as either primary or secondary:
Primary Prevention – No cardiac events have occurred in the patient. The doctor wants to prevent an initial cardiac event.
Secondary Prevention – A cardiac event has happened in the past. The doctor will try to prevent another event from occurring.
For instance, a patient who has had a heart attack or stroke is generally treated with secondary prevention using drugs like aspirin, cholesterol lowering medications to reduce the chance of another event occurring. Patients who have not yet had an event such as a heart attack or stroke are at much lower risk. Finding the appropriate level of prevention in these patients is often difficult because of this lower risk.
Aspirin for Primary Prevention
It has been the practice for decades now to use low-dose aspirin, particularly for adults over age 50. This approach has been felt to reduce the chance of a heart attack or stroke, mostly by providing a slight blood thinning effect. Aspirin acts as a blood thinner by inhibiting the actions of platelets in the blood. This antiplatelet effect has been shown to be very significant for patients having a heart attack or for after having a heart attack. The logic therefore was extended to include patients who are at risk for heart attacks.
We have generally recommended aspirin at low dose (81 mg) for primary prevention for patients over age 50. The data was felt to be reasonably strong for men and less strong for women.
New FDA Recommendations
Now, the FDA no longer recommends that this practice be continued. The May 2014 FDA statement says:
“The FDA has reviewed the available data and does not believe the evidence supports the general use of aspirin for primary prevention of a heart attack or stroke. In fact, there are serious risks associated with the use of aspirin, including increased risk of bleeding in the stomach and brain, in situations where the benefit of aspirin for primary prevention has not been established.”
The FDA did caution patients not to stop aspirin without consulting their physician. They also tried to educate the public about the differences between primary and secondary prevention and have clearly stated that this new recommendation only pertains to primary prevention. Patients who had prior evidence of vascular disease with heart attack, stroke, prior angioplasty or other vascular procedure, or even with imaging evidence of significant vascular disease in the carotid arteries or vascular disease of the legs, should continue aspirin if recommended by their physicians.