AMSTERDAM, Netherlands — Heart attack survivors who take aspirin daily are likely to live longer, a new study explains. According to a team in Denmark, regular aspirin consumption reduces the likelihood of experiencing another heart attack or stroke compared to those who do not consistently use the pain reliever.
“Our findings suggest that not taking aspirin as prescribed after a heart attack is linked to a higher risk of having another heart attack, a stroke or dying,” says study author Dr. Anna Meta Kristensen of Bispebjerg and Frederiksberg Hospital in Denmark.
“We recommend that all patients who have had a heart attack stay adherent to their aspirin in accordance with guidelines until randomized controlled trials have proven otherwise, and clinical guidelines have been changed.”
Aspirin is crucial after a heart attack because it hinders blood clot formation, thereby reducing the risk of subsequent heart attacks or strokes. However, as treatment and diagnostic methods advance, and post-heart attack prognoses improve, the long-term benefits of aspirin have become less clear. Notably, while aspirin does prevent clotting, it also ups the bleeding risk. The equilibrium between cardiovascular benefits and bleeding risk shifts as time passes post-heart attack.
The research delved into the risks of stopping long-term aspirin usage versus its continued consumption after a heart attack in modern settings. Data was sourced from the Danish nationwide health registries, encompassing patients age 40 and older. These patients, having experienced their first heart attack between 2004 and 2017, received coronary stent treatments and adhered to prescribed aspirin for the initial year post-incident. Exclusions were made for patients on anticoagulants or those who had recurrent heart attacks or strokes within the year.
In Denmark, every aspirin prescription collection, including the number of tablets and collection date, is recorded. Aspirin adherence was tracked at the second, fourth, sixth, and eighth year post-heart attack. Adherence assessment was based on the proportion of days patients had their aspirin in the prior two years. The team considered those on aspirin for 80 percent of the time or less non-adherent, while the rest were categorized as adherent.
“We assessed the effects of long-term aspirin use in patients who were not receiving other medications for the prevention of heart attack or stroke. Both anticoagulants and P2Y12 inhibitors are agents that, similar to aspirin, work to prevent the formation of blood clots. Therefore, patients undergoing such treatments were excluded from our study,” Dr. Kristensen explains in a media release.
Over 40,000 first-time heart attack patients were included in the study. Aspirin adherence saw a gradual drop, from 90 percent at two years to 81 percent by the eighth year post-heart attack. The study also examined whether non-adherent patients faced higher risks of heart attack recurrence, stroke, or death.
Findings showed that those regularly taking aspirin consistently had better outcomes. Specifically, non-adherent patients had a 29, 40, 31, and 20-percent higher likelihood of facing adverse events at the 2nd, 4th, 6th, and 8th-year post-heart attack respectively, in comparison to adherent patients.
“Our results should be interpreted with caution because they show an association but do not establish causality. Since the study is registry-based, we do not have information about the specific reasons as to why patients did not take their aspirin,” Dr. Kristensen concludes.
“Furthermore, our findings cannot be generalized to all patients who experience a heart attack, as our study specifically focused on those who received treatment with a coronary stent and were not taking other medications to prevent blood clot formation. With that in mind, the results support current guidelines recommending long-term aspirin after a heart attack.”
The researchers are presenting their findings at ESC Congress 2023 in Amsterdam.
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South West News Service writer Stephen Beech contributed to this report.