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Does Aspirin Really Lower Heart Attack Risk?

aspirinWe have all believed that aspirin use will lower the risk of heart attack, mostly because it thins the blood. The problem I have always foudn though is that too much aspirin will stop the blood from clotting quickly and this in itself almost led to a quick trip to the hospital for my wife last year.

This new study below though seems to show that it is not so obvious as to weather Aspirin really helps to prevent heart attacks but in itself it is a good read with lots of findings

Long-term, low-dose aspirin provides no clear net value for primary prevention of cardiovascular events in apparently healthy adults, according to a meta-analysis of patient-level data.

In people not known to have cardiovascular disease, aspirin reduced composite MI, stroke, and vascular death rates to 0.51% per year compared with 0.57% among controls for a relative 12% reduction, according to Colin Baigent, B.M.B.Ch., of the University of Oxford, England, and colleagues in the Antithrombotic Trialists’ Collaboration.

But the major gastrointestinal and extracranial bleeding rate rose from 0.07% per year among controls to 0.10% among those receiving aspirin for primary prevention (, the researchers reported in the May 30 issue of The Lancet.

Aspirin Bleeding Risks

Importantly, the bleeding risk rose right along with cardiovascular risk level, the cooperative group said.

Guidelines from the U.S. Preventive Services Task Force and the American Heart Association largely ignore any differences in bleeding risk, and recommend wide use of aspirin for primary prevention in patients at moderately elevated heart disease risk, the researchers noted.

However, there was no threshold cardiovascular risk level that appeared to have a sufficient benefit-to-bleeding risk ratio among the 95,000 participants in the six long-term primary prevention trials included in the meta-analysis, Dr. Baigent said.

“Current guidelines may need to be reviewed,” he said.

Lowering Heart Attack Risk Factors

For primary prevention, “the main strategies ought to be really stopping smoking — if people smoke — then if further measures are needed, lowering blood pressure, lowering cholesterol,” Dr. Baigent said. “The benefits of adding aspirin to all that does not clearly outweigh the hazards.”

In the meta-analysis, the benefit for major coronary event risk reduction was driven by a 23% proportional reduction in nonfatal MI (0.18% with aspirin versus 0.23% for controls per year.

The number needed to treat for one year to prevent one non-fatal heart attack was 2,000, Dr. Baigent said.

No clear reduction in mortality from coronary heart disease (0.11% versus 0.12% per year) or overall mortality emerged with use of long-term, low-dose aspirin.

The relative risk reduction appeared similar for men and women  and for those at each level of cardiovascular risk  with predicted 5-year risk of coronary heart disease rising from less than 2.5% to 10% or more).

Older age, male sex, diabetes, and high blood pressure were associated with significantly elevated absolute ischemic stroke and major coronary event risk, but also with significantly increased risk of major extracranial bleeding and at least a trend for hemorrhagic stroke as well.

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Weight Loss Exercise

Does Aspirin Really Lower Heart Attack Risk?

aspirinWe have all believed that aspirin use will lower the risk of heart attack, mostly because it thins the blood. The problem I have always foudn though is that too much aspirin will stop the blood from clotting quickly and this in itself almost led to a quick trip to the hospital for my wife last year.

This new study below though seems to show that it is not so obvious as to weather Aspirin really helps to prevent heart attacks but in itself it is a good read with lots of findings

Long-term, low-dose aspirin provides no clear net value for primary prevention of cardiovascular events in apparently healthy adults, according to a meta-analysis of patient-level data.

In people not known to have cardiovascular disease, aspirin reduced composite MI, stroke, and vascular death rates to 0.51% per year compared with 0.57% among controls for a relative 12% reduction, according to Colin Baigent, B.M.B.Ch., of the University of Oxford, England, and colleagues in the Antithrombotic Trialists’ Collaboration.

But the major gastrointestinal and extracranial bleeding rate rose from 0.07% per year among controls to 0.10% among those receiving aspirin for primary prevention (, the researchers reported in the May 30 issue of The Lancet.

Aspirin Bleeding Risks

Importantly, the bleeding risk rose right along with cardiovascular risk level, the cooperative group said.

Guidelines from the U.S. Preventive Services Task Force and the American Heart Association largely ignore any differences in bleeding risk, and recommend wide use of aspirin for primary prevention in patients at moderately elevated heart disease risk, the researchers noted.

However, there was no threshold cardiovascular risk level that appeared to have a sufficient benefit-to-bleeding risk ratio among the 95,000 participants in the six long-term primary prevention trials included in the meta-analysis, Dr. Baigent said.

“Current guidelines may need to be reviewed,” he said.

Lowering Heart Attack Risk Factors

For primary prevention, “the main strategies ought to be really stopping smoking — if people smoke — then if further measures are needed, lowering blood pressure, lowering cholesterol,” Dr. Baigent said. “The benefits of adding aspirin to all that does not clearly outweigh the hazards.”

In the meta-analysis, the benefit for major coronary event risk reduction was driven by a 23% proportional reduction in nonfatal MI (0.18% with aspirin versus 0.23% for controls per year.

The number needed to treat for one year to prevent one non-fatal heart attack was 2,000, Dr. Baigent said.

No clear reduction in mortality from coronary heart disease (0.11% versus 0.12% per year) or overall mortality emerged with use of long-term, low-dose aspirin.

The relative risk reduction appeared similar for men and women  and for those at each level of cardiovascular risk  with predicted 5-year risk of coronary heart disease rising from less than 2.5% to 10% or more).

Older age, male sex, diabetes, and high blood pressure were associated with significantly elevated absolute ischemic stroke and major coronary event risk, but also with significantly increased risk of major extracranial bleeding and at least a trend for hemorrhagic stroke as well.

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Aerobic Fitness declines with age

Ran into this interesting article from Reuters:

Jul 26 (Reuters Health) – Physical fitness is known to wane with age, but a study published Monday shows that the decline gains speed with each decade, regardless of a person’s exercise habits.
The study of 810 healthy adults found that the rate of decline in aerobic fitness was about four times greater among people in their 70s or older, compared with those in their 20s and 30s.

Despite the fact that it boosts aerobic fitness, regular exercise did not change a person’s rate of age-related decline.

However, that does not mean it’s time to retire those running shoes, according to the study authors.

At any given age, people who were at least moderately active were more fit than their sedentary peers, said lead author Dr. Jerome L. Fleg of the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

In addition, he told Reuters Health, research shows that older people can improve their aerobic capacity by getting regular, moderate exercise like walking. The point, according to Fleg, is to help elderly people stay fit enough to perform daily activities — like housework or yard work — and maintain their independence as long as possible.

Fleg and his colleagues at the National Institutes of Health report their findings in Circulation, a medical journal published by the American Heart Association.

The study looked at changes over time in individuals’ VO2max, a measure of aerobic fitness that refers to how much oxygen the body uses during a given activity. The VO2max is the point at which the body can no longer ramp up its oxygen use to keep up with the intensity of the exercise, and the activity rapidly becomes unsustainable.

It’s well known that a person’s VO2max declines with age. But the rate of that decline, Fleg explained, has not been clear-in large part because studies on the subject have typically compared different age groups rather than following the same people over time.

His team’s study included healthy men and women between the ages of 21 and 96 who periodically underwent treadmill tests to gauge their VO2max. The researchers also charted changes in participants’ blood pressure, body composition and lifestyle habits, over an average of eight years of follow-up.

In general, the study found, VO2max declined by 3 to 6 percent per decade while people were in their 20s and 30s. The rate of decline increased with age, going above 20 percent per decade among adults in their 70s or older.

The “good news,” Fleg said, is that active people maintained a higher VO2max than sedentary people their age, pointing to the importance of staying active throughout life.

He noted that older, sedentary adults who want to boost their fitness should consult their doctors before starting to exercise, as should anyone with heart disease.

SOURCE: Circulation, August 2, 2005.
Publish Date: July 26, 2005