Lucia Helena – Aspirin: don’t fall into the controversy that would increase heart risks

It has been talked about abroad and has also had an echo in the Brazilian press: researchers from the University of Leuven, in Belgium, have published an article in the journal of the European Society of Cardiology stating that taking aspirin would not only be an completely useless to prevent problems of people with cardiovascular risk, but it would even increase their propensity to develop heart failure by 26%. For what!

The fuse of the controversy was lit and the bomb exploded in the hands of people with coronary heart disease who use the medicine on a daily basis and who, understandably, were quite frightened. It doesn’t matter, I’ll let you know right away.

“Without the eye of someone who knows science, this work leads to a problem of interpretation”, warns cardiologist Andrei Sposito, professor at the Faculty of Medical Sciences of Unicamp (State University of Campinas), who published in the same journal of the European , with sweet irony, a careful meta-analysis – in this case, the comparison of four important studies on the subject -, signing together with colleagues from other institutions, such as UCB (Catholic University of Brasilia) and UFRGS (Federal University of Rio Big do Sul).

Brazilian scientists prove it’s not good. We have to go back a few steps for everyone to understand this story.

after a heart attack

Now, acetylsalicylic acid, the name of the active ingredient in the old aspirin, has been recognized since the 1980s to reduce the mortality of those who have already suffered a heart attack. And there is no discussion about this.

“It prevents blood platelets from clumping together, which is the key step in forming a thrombus.” The clot would be able to obstruct the passage of circulation in an artery of the heart, for example. Then, you see, it’s a heart attack.

Understand: the heart muscle never comes out of it as if nothing had happened. The area that has not been supplied with oxygenated blood is no longer the same. The result is a loss of power to pump the circulation, the so-called insufficiency.

By the way, other than unrequited love, anything that makes someone’s heart ache ends in heart failure. And it kills half the patients in five years.

So by going back to the aspirin pill, by preventing a blood clot, it prevents an already punished heart from hurting again, complicating this situation. For this group of patients, fearing the drug because they’ve heard about the Belgian study is what may increase their risk, that’s for sure.

And before the subject had a heart attack?

The Belgian study isn’t the first to raise suspicions that aspirin may do more harm than good. The confusion begins as scientists try to figure out what the benefit of medicine would be before a heart attack itself.

In the past, a wave has emerged that anyone should make it a habit to swallow an aspirin every single day to protect the heart. And no, she won’t be the chest protector of the healthy. Incidentally, without indication, constant use can cause bleeding, among other damages.

“In Brazil, this idea of ​​protective action has become a layman’s domain and, worse, here we have aspirin for children,” comments Sposito. “This is where people think it’s okay to self-medicate because, after all, the dose would be low, even a child could take it without any harm. That’s a huge mistake. For an adult, the dose may be low for him the effect anti-inflammatory that this medicine has. But it is enough for a total blockage of platelets.” Therefore, never ingest acetylsalicylic acid at all. Much less everyday.

However, there is a gray area, that of people who have not yet had a heart attack, but who accumulate a number of factors for it to happen more days, less days. “Being middle-aged or even older, having high cholesterol, having high blood pressure… All of this matters, as does a calcium test result and carotid artery ultrasound to evaluate plaque in the arteries,” exemplifies Sposito.

Cardiologists use this information to stratify each person’s risk: Mine might be higher than yours, or vice versa. If he’s up to it, they often consider prescribing daily aspirin, seeing the possibility of a heart attack around the corner, with heart failure on the sidelines.

The strategy of using aspirin before a heart attack — what doctors call primary prevention — is what’s in the spotlight. Some researchers point to little benefit in the face of side effects. Would it be worth it then?

“In this decision, my American colleagues are still on the fence,” says Sposito. “European cardiologists, seeing that they had to choose between the risk of gastrointestinal bleeding and the risk of a heart attack that probably wouldn’t be fatal, realized that there would be no point in trading one disease for another.”

That is, in Europe, guidelines no longer recommend aspirin for high-risk patients who have never had a heart attack. However, in developing countries like Brazil, the scenario is different: heart attacks still kill a lot and cases of heart failure are rising unabated. So, before discarding the alternative, it is necessary to delve into aspirin in cases where the cardiovascular risk is stratospheric.

When risk is relative

The Leuven scientists looked at data from 30,000 Americans and Europeans with an average age of 67 to see the possible effect of aspirin on heart failure prevention. It is, in fact, a question of a number of people beyond the reasonable.

A quarter of them reported that they swallowed the pill every day to avoid heart problems. Therefore, the researchers compared who took and who did not take the medicine. Thus, they observed a 26% increase in the risk of heart failure being propagated in the lay media. But… oops! – missing an adjective that would make a total difference: they were talking about relative risk.

Andrei Sposito makes an analogy: “You feel that the price of things has increased by 26% and you deduce, from that information alone, that everything has become too expensive to pay for. If it is the value of a match, it will still cost anyway.” little that way. If it’s a car, maybe that difference makes it too expensive for your savings.” Here: the relative risk depends on the starting point of each, whether they already had signs of the disease or not.

“Another problem is that they used an existing database,” recalls Sposito. In fact, these 30,000 people had originally participated in another study that wasn’t designed to evaluate aspirin use. “Therefore, it was not recorded how long they had been using the medicine, whether or not they already had signs of insufficiency and – which would be very important to know – whether they took the pill themselves or had been seen by the doctor,” explains Sposito.

Think: Anyone who has gone to the doctor and walked away with a prescription for aspirin to prevent heart attacks presumably already had a problem with their coronary arteries. “Therefore, without the drug there would be an explosion of heart attacks in this group and an even greater increase in the risk of heart failure.”

The Belgian article even ventures hypotheses about why aspirin would cause more heart failure. It stresses, for example, anemia caused by occasional bleeding in the digestive tract, and yes, anemic blood makes it worse for the heart muscle.

For Sposito, however, hypotheses like this serve, at best, as elevator speech. “It would take a very serious hemorrhage to mess with iron and, in turn, the anemia would have to be chronic to interfere with the heart,” guarantees the Unicamp professor. The threat of aspirin letting things get to that point is remote.

A very slight increase in risk

In their meta-analysis, Sposito and colleagues first looked at the 1909 works, but rejected most of them precisely because they had one flaw here, another there.

“We wanted to compare data from randomized studies, i.e. in which people were randomly selected to take aspirin or a fake drug, but without knowing whether they were part of one group or another so as not to have any interference,” he explains. .

Ultimately, the analysis was of four studies involving a total of 40,418 patients. And the conclusion is reassuring: less than 1% of all those who took aspirin, an absolute minority, had an increased risk of heart failure greater than 15%.

The important thing, as the cardiologist points out, is that you seek advice from your doctor when you read anything else about the drug you’re using before making the decision to abandon it. The message doesn’t just apply to aspirin, by the way.

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