Aspirine
tegen hart- en vaatziektes.*
Aspirine lijkt bij lage dosis beter te werken tegen hart- en vaatziektes dan dure medicijnen. Acetylsalicylzuur, wat de meeste mensen kennen als aspirine is een stof die al heel lang bekend is en de oudheid als sap uit wilgenbast gebruikt werd als pijnstiller.
In deze studie onder bijna 10.000 stabiele hartpatiënten werden lage dagelijkse dosis, tussen de 81 en 325 mg, aspirine gebruikt. De resultaten: door 30 mensen met deze dosis te behandelen wordt 1 serieus hartprobleem voorkomen; bij 40 mensen kan men 1 beroerte voorkomen; bij 71 mensen 1 dood voorkomen en bij 83 mensen 1 hartaanval voorkomen. Deze cijfers zijn veel beter dan de resultaten met (dure) medicijnen. Aspirine heeft alleen een kleine bijwerking, de kans op een bloeding. Bij 1 op 111 gebruikers is die kans aanwezig.
Cardiovascular
Events Reduced By Low-Dose Aspirin
Taking
low-dose aspirin daily reduces the risk of heart attack and stroke, as well as
the risk of dying, among patients who previously have had a heart attack or
stroke but whose cardiovascular disease has stabilized, according to a new
analysis by Duke University Medical Center cardiologists.
The study also found that taking low-dose aspirin daily increases a patient's
risk of bleeding, but the researchers said the protective benefits of aspirin
outweigh this side effect. A daily dose of aspirin is considered low if it is
between 81 milligrams and 325 milligrams.
"Among patients with stable cardiovascular disease, we found that low-dose
aspirin reduced incidence of heart attack, stroke and death," said
cardiology fellow Jeffrey Berger, M.D., who presented the results of the study
on Wednesday, Nov. 15, at the annual scientific sessions of the American Heart
Association, in Chicago.
"We also saw an increased risk of bleeding among patients taking aspirin,
but as in the decision-making process involving any therapy, there is always the
weighing of benefits and risks," Berger added. "Since a great majority
of patients can tolerate aspirin, the benefits appear to outweigh the risks.
Aspirin is a drug that has been used for many years. It is well-understood,
effective, inexpensive and widely available. In aspirin we have a proven
life-saver."
The study was supported by Duke's Division of Cardiology.
Aspirin exerts its protective effect by preventing the clumping together of
platelets circulating in the blood, according to the researchers. It is this
anticlotting action that also causes unwanted bleeding.
In the Duke study, Berger and colleagues combined the data from six clinical
trials that enrolled patients with stable cardiovascular disease or stable
angina, or chest pain, and gave them low-dose aspirin. In total, the trials
included 9,853 patients.
The researchers found that patients who took low-dose aspirin had a 26 percent
reduction in the risk of a nonfatal heart attack, a 25 percent reduction in the
risk of stroke and a 13 percent reduction in risk of death, compared with
similar heart patients who did not take aspirin. Taken together, Berger said,
patients on low-dose aspirin had a 21 percent reduction in risk of experiencing
a major cardiovascular event, a measurement that is the combination of the rates
of nonfatal heart attack and stroke and of cardiovascular death.
In terms of aspirin's effect in promoting bleeding, the study found that one
patient out of 111 who received low-dose aspirin experienced a bleeding episode,
Berger said.
Putting the results another way, Berger said, the results suggest that treating
83 patients will prevent one nonfatal heart attack, treating 40 patients will
prevent one stroke, treating 30 patients will prevent one major cardiovascular
event and treating 71 patients will prevent one death.
"When compared to other medications that have been proven effective in
preventing cardiovascular events, aspirin comes off looking very good,"
Berger said.
For example, 91 patients would need to be treated with ACE inhibitors to prevent
one death, compared with 71 patients for aspirin, he said. ACE inhibitors dilate
blood vessels, making it easier for the heart to pump blood. Ninety-one patients
would need to be treated with the inhibitors to prevent one heart attack,
compared with 83 for aspirin, and 167 would need to be treated with the
inhibitors to prevent one stroke, compared with 40 patients with aspirin.
"These comparisons show that a cheap and inexpensive medicine like aspirin
is just as good, if not better, than other expensive medicines," Berger
said.
Still, there is room for improvement in aspirin therapy, he said. In particular,
he said, more study is needed to identify what dosage in the low-dose range --
from 81 milligrams to 325 milligrams a day -- will provide the best
benefit-to-risk profile.
Other members of the research team were Richard Becker of Duke and David Brown
of the State University of New York-Stony Brook Medical Center. (Nov.
2006)