June 19, 2013
Should Preventative Aspirin Use Broaden Because of
Chapel Hill, NC— A study led by a new member of the U.S. Preventive Services Task Force questions whether aspirin’s possible role in reducing cancer deaths should be considered in guidelines on how the common drug should be used for prevention purposes.
Aspirin has been shown to be effective in preventing heart attacks in men, but also increases the risk of gastrointestinal bleeding and possibly stroke, even at low doses. To assure that benefits outweigh the adverse effects, national guidelines currently call for the use of aspirin as a preventative only in men at higher risk for cardiovascular events.
Numerous reports also have suggested that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help prevent cancer.
A study led by Michael Pignone, MD, MPH, a recently appointed member of the task force and professor of medicine and chief of the division of general internal medicine at the University of North Carolina-Chapel Hill, calls into question whether the possible combined health benefits of reducing heart attacks and cancer outweigh the risks of gastrointestinal bleeding and stroke for a larger number of middle-aged men.
Using a base case scenario of 45-year-old men, researchers examined costs and quality-adjusted life years for men taking aspirin for 10 years compared with men who were not taking aspirin over those 10 years. After 10 years, the study equalized treatment and followed the cohort until death.
“We found that including a risk reduction for cancer deaths had a substantial impact on the overall benefits of aspirin, especially for early middle-aged men from 45 to 55 years of age,” Pignone said. “Based on this effect, several million men who were not previously good candidates for aspirin prevention would now become eligible.”
The study concludes, “Including an effect of aspirin on cancer mortality influences the threshold for prescribing aspirin for primary prevention in men. If such an effect is real, many middle-aged men at low cardiovascular risk would become candidates for regular aspirin use.”
The U.S. Preventive Services Task Force recommends aspirin for primary prevention in men “when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage.” The recommendation was issued in 2009, before the potential benefits for cancer reduction were recognized, according to the study.
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