The Israel Heart Society has instructed doctors not to recommend aspirin as treatment to prevent heart disease for the general adult population. Instead, the controversial drug will be administered on the basis of doctors' assessment of risks for each patient.
The IHS has recently issued, for the first time, instructions for aspirin treatment to prevent heart disease, following contradictory studies about the drug's effectiveness.
The instructions, written by a team of experts, headed by Professor Chaim Yosefi, head of cardiology in Barzilai Medical Center, have been approved by the Israel Medical Association's quality assurance department.
Doctors are recommended not to prescribe aspirin to the adult population routinely. "Doctors must assess each patient's chances of heart and vascular disease and weigh them against the risks of internal bleeding," the instructions say.
Doctors are instructed to administer aspirin according to the patient's calculated risk of having a heart attack, similar to the instructions for treatment with lowering bad cholesterol (LDL ) with drugs from the statins group.
They must determine the risk for a heart attack, according to the patient's risk factors, including previous heart events, smoking, high blood pressure, a surplus of blood lipids (fats ) and diabetes.
High risk patients
Aspirin is recommended for patients with a high risk for a heart event, including diabetics, men over 50 and women over 60 who suffer from at least one or more risk factors, unless they have an increased risk for bleeding in the digestive system.
In certain cases of patients with medium risk for a heart attack, who suffer from at least two risk factors, doctors may consider regular aspirin treatment.
These include patients with a relative who suffered from chronic heart disease at a young age, patients with metabolic syndrome or arteriosclerosis.
Doctors must take special care with patients over 80, who run a higher risk of bleeding. They should consider treating women with aspirin only after the age of 65, due to the bleeding risk in younger women.
Aspirin is not recommended as treatment to prevent heart disease for people, especially young ones, who smoke, have high blood pressure or have some other risk factor for heart disease.
The Heart Society's recommended daily aspirin dose for preventing heart diseases of 75-100 mg.
Tens of thousands of adults in Israel are estimated to be treated with aspirin to prevent heart disease. More than 40 million Americans take aspirin daily to prevent heart disease, from 81 to 325 mg., according to figures from the United States.
"The instructions are expected to reduce the aspirin use in Israel," says Professor Doron Zager.
In 1989, a study showed that a regular aspirin dose every two days for five years reduced the risk for heart disease or mortality from it by 44 percent in patients over 50.
However, scientists from the University of Edinburgh published a study last summer saying aspirin is ineffective in preventing heart disease in healthy people. It may even cause damage, as it increases the risk for hospitalization with internal bleeding by 71 percent, the study says.
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