Charles H. Hennekens, M.D., Co-Director of Cardiovascular Research at MSMC-MHI, and Professor of Medicine & Epidemiology and Public Health at the University of Miami School of Medicine was the first to demonstrate the benefit of aspirin in reducing the risk of a first heart attack in a landmark Physicians' Health Study (PHS), which was published in 1988 in the New England Journal of Medicine. Under his direction, Rachel S. Eidelman, M.D., a cardiology fellow at MSMC-MHI, performed the latest meta-analysis.
The findings strongly support the treatment guidelines issued by the American Heart Association (AHA), which recommends the use of aspirin for all men and women whose 10-year risks of a first coronary event are 10 percent or greater. The U.S. Preventive Services Task Force (USPSTF) released similar guidelines earlier in 2002, urging all healthcare providers to consider the use of aspirin in all apparently healthy men and women with a 6 percent or greater 10-year risk of a coronary event.
"The individual trials and their meta-analysis support the AHA and USPSTF guidelines, which note that the benefits of long-term aspirin use are likely to outweigh any risks for these individuals," Hennekens said. "The more widespread and appropriate use of aspirin in primary prevention could avoid hundreds of thousands of first heart attacks and important vascular events each year in the U.S."
The aspirin component of Dr. Hennekens trial, the PHS, was terminated early on January 25, 1988 based on the unanimous recommendations of the Data and Safety Monitoring Board, due primarily to a statistically extreme 44 percent reduction in risk of a first heart attack among those assigned at random to aspirin. There have been four primary prevention trials published since then, three of which showed similar positive findings for aspirin.
"We found that the current totality of evidence strongly supports our initial findings from the Physicians' Health Study that aspirin significantly reduces the risk of a first heart attack in apparently healthy individuals," Hennekens added. "This data, along with the findings that aspirin reduces the risk of death by 23 percent if given during a heart attack and by 15 percent in a wide range of people who have survived prior cardiovascular events, demonstrate the need for wider utilization of aspirin."
"Yet despite the clearly demonstrated cardio-protective benefits of aspirin, this medication remains alarmingly underutilized among survivors of prior events, those having a heart attack and apparently healthy men and women, whose 10-year risk is 10 percent or more," Hennekens continued. "We hope the latest findings result in greater awareness on the part of healthcare providers and the general public and motivate increased aspirin utilization, which could result in significant reductions of premature cardiovascular deaths and first heart attacks."
Coronary heart disease is the single leading cause of death in the United States, accounting for more than 500,000 deaths annually. Approximately 80 percent of deaths from coronary heart disease in people under age 65 occur during the first heart attack.
Mount Sinai & Miami Heart's Cardiovascular Center of Excellence is committed to being a leader in the prevention, diagnosis and treatment of heart disease. The medical center is the largest cardiac services provider in South Florida, conducting approximately 1,300 open heart procedures and approximately 7,400 diagnostic and therapeutic cardiac catheterizations annually.
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Journal
Archives of Internal Medicine