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Skipping Aspirin After Heart Attack Increases Risks

Skipping Aspirin may increase the likelihood of heart attacks and strokes.
Skipping Aspirin may increase the likelihood of heart attacks and strokes. Credit: Phillip Jeffrey / Flickr / CC BY-NC-ND 2.0

After experiencing a heart attack, your doctor probably advised you to take a small dose of aspirin every day. This is to lower the risk of having another heart attack or stroke. However, many people do not stick to this advice for a long time.

A recent study has shown that those who do not consistently take their daily low-dose aspirin are more likely to experience another heart attack, stroke, or even death. This is in comparison to those who regularly take aspirin.

Aspirin helps to prevent blood cells called platelets from clumping together. This is important because it reduces the chances of blood clots forming, which can lead to heart attacks and strokes.

Dr. Deepak Bhatt, a respected expert in cardiovascular medicine from the Icahn School of Medicine in New York City, said, “Most people should be on lifelong aspirin after a heart attack.”

He further said, “Long-term adherence to medication is a problem worldwide, including in the USA, and this is true even for inexpensive drugs such as aspirin, which can be life saving in heart attack patients.”

Details of the research

The research effort was spearheaded by Dr. Anna Meta Kristensen from Bispebjerg and Frederiksberg Hospital in Frederiksberg, Denmark.

In the investigation, over 40,100 individuals aged forty and over, all of whom had encountered a first-time heart attack between 2004 and 2017, were tracked. The researchers monitored their usage of aspirin at intervals of two, four, six, and eight years following their heart attacks.

The objective was to determine who among them consistently adhered to a daily aspirin regimen. Individuals who were taking other blood thinners were not considered within the study.

Those who were on aspirin eighty percent of the time or less were categorized as non-adherent, meaning they didn’t take aspirin as directed. On the other hand, individuals who took aspirin eighty percent of the time or more were considered adherent, as they followed the prescribed regimen.

Results of the study

The study revealed that after two years, ninety percent of individuals who had survived a heart attack were still consistently taking their daily aspirin. However, this percentage dropped to eighty-four percent at four years, eighty-two percent at six years, and ultimately to eighty-one percent at eight years.

Interestingly, those who did not adhere to consistent aspirin use faced greater risks. These risks included a higher likelihood of experiencing another heart attack, suffering a stroke, or facing mortality during the entire follow-up period.

Notably, at the four-year mark, non-adherent patients exhibited a forty percent higher risk compared to patients who faithfully followed their low-dose aspirin regimen.

The study’s results will be shared at the European Society of Cardiology gathering in Amsterdam, scheduled for August 25tj to 28th.

However, it is crucial to note that findings presented during medical conferences are preliminary in nature and should be regarded as such until they have undergone review by fellow experts and are published in a peer-reviewed journal.

Dr. Silvia Castelletti, a cardiologist based in Milan, Italy, commented on the study’s significance. She stressed that “this study emphasizes the importance of correctly taking aspirin after experiencing a first cardiovascular event.”

She further added that “doing so reduces the chances of having another heart attack, as well as the risks of stroke or death.”

Reasons behind decline is aspirin usage

The study’s primary purpose did not involve investigating the reasons behind the decline in aspirin usage over time, and it cannot establish a cause-and-effect relationship.

Dr. Silvia Castelletti remarked that patients often overlook taking aspirin when they are prescribed multiple medications. Furthermore, some patients might encounter gastrointestinal problems associated with aspirin and make the decision to discontinue its use independently.

While aspirin contributes to a reduction in the risk of heart attacks and strokes, it’s important to recognize that it could also elevate the likelihood of gastrointestinal bleeding and the development of stomach ulcers.

Dr. Castelletti proposed strategies to mitigate these risks. She advised taking aspirin during main meals and consistently using medications that protect the stomach lining.

Proton pump inhibitors like Nexium, Prevacid, and Prilosec can help decrease gastrointestinal side effects linked with aspirin usage. Numerous factors contribute to individuals’ lack of adherence to aspirin recommendations, as mentioned by Dr. Bhatt. “At the time of a heart attack, patients are not feeling well and are focused on doing whatever is necessary to get better,” he explained.

As time progresses from the heart attack and they begin to feel better, there might be decreased motivation to continue preventive medication. Regrettably, this behavior elevates their vulnerability to experiencing another heart attack.

Facts supported by other studies

A related study, published in the August 22nd edition of the Journal of the American Medical Association, shed light on the inadequate utilization of daily aspirin after a heart attack on a global scale.

Remarkably, less than half of all individuals worldwide who have suffered a heart attack or stroke incorporate daily low-dose aspirin into their routine. Unfortunately, these statistics have shown minimal improvement over the past decade.

Dr. Sang Gune K. Yoo, one of the study’s authors, acknowledged the widespread underuse of aspirin. He called for interventions at the level of both patients and healthcare providers to enhance its utilization.

Dr. Yoo, who is affiliated with the cardiovascular division at Washington University School of Medicine in St. Louis, noted that the solution likely involves multifaceted approaches. This could encompass better educating patients about the advantages of aspirin therapy following a heart attack and ensuring increased availability of aspirin.

Suitability of Aspirin for patients

It is worth highlighting that not all individuals who have survived a heart attack can or should incorporate aspirin into their regimen to prevent a subsequent heart attack. “If a patient is allergic to aspirin, it should not be used in their therapy after a heart attack,” emphasized Dr. Silvia Castelletti.

Dr. Yoo concurred with Dr. Castelletti’s viewpoint that aspirin isn’t suitable for every heart attack survivor. “It’s important to discuss the risks and benefits with your doctor,” Dr. Yoo emphasized.

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